Stapling adjunct attachment

ABSTRACT

Methods for applying one or more adjuncts to tissue are provided. In one embodiment, the method can include positioning an adjunct, e.g., using an adhesive, on one of first and second jaws of an end effector of a surgical stapler. In one embodiment, an attachment mechanism on the adjunct can prevent stretching of at least a portion of the adjunct. In other aspects, the adjunct can be maintained on the at least one jaw in a first state in which the adjunct is at least partially stretched over the at least one jaw, and actuation of the surgical stapler can cause the adjunct to transition from the first state to a second state such that the adjunct in the second state at least partially separates from the at least one jaw.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application is a continuation of U.S. patent applicationSer. No. 15/436,394 filed on Feb. 17, 2017, entitled “Stapling AdjunctAttachment,” which is hereby incorporated by reference in its entirety.

FIELD

Methods and devices are provided for securing one or more adjunctmaterials to an end effector of a surgical instrument.

BACKGROUND

Surgical staplers are used in surgical procedures to close openings intissue, blood vessels, ducts, shunts, or other objects or body partsinvolved in the particular procedure. The openings can be naturallyoccurring, such as passageways in blood vessels or an internal organlike the stomach, or they can be formed by the surgeon during a surgicalprocedure, such as by puncturing tissue or blood vessels to form abypass or an anastomosis, or by cutting tissue during a staplingprocedure.

Most staplers have a handle with an elongate shaft having an endeffector with a pair of movable opposed jaws for engaging and staplingtissue. The staples are typically contained in a staple cartridge, whichcan house multiple rows of staples and that is often disposed in one ofthe jaws for ejection of the staples to the surgical site. In use, thejaws are positioned to engage tissue, and the device is actuated toeject staples through the tissue. Some staplers include a knifeconfigured to travel between rows of staples in the staple cartridge tolongitudinally cut the stapled tissue between the stapled rows.

While surgical staplers have improved over the years, a number ofproblems still present themselves. One common problem is that leaks canoccur due to the staple forming holes when penetrating the tissue orother object in which it is disposed. Blood, air, gastrointestinalfluids, and other fluids can seep through the openings formed by thestaples, even after the staple is fully formed. The tissue being treatedcan also become inflamed due to the trauma that results from stapling.Still further, staples, as well as other objects and materials that canbe implanted in conjunction with procedures like stapling, generallylack some characteristics of the tissue in which they are implanted. Forexample, staples and other objects and materials can lack the naturalflexibility of the tissue in which they are implanted. A person skilledin the art will recognize that it is often desirable for tissue tomaintain as much of its natural characteristics as possible afterstaples are disposed therein.

Accordingly, there remains a need for improved devices and methods forstapling tissue, blood vessels, ducts, shunts, or other objects or bodyparts such that leaking and inflammation is minimized whilesubstantially maintaining the natural characteristics of the treatmentregion.

SUMMARY

Methods for stapling tissue are provided. In one embodiment, the methodcan include positioning an adjunct on one of first and second jaws of anend effector of a surgical stapler. The adjunct can have an adhesivethereon that maintains the adjunct on the jaw. The method can alsoinclude positioning tissue between the first and second jaws, andactuating the surgical stapler to cause the first and second jaws tomove from an open position to a closed position in which the tissue isengaged therebetween. A first attachment mechanism on the adjunct canprevent stretching of at least a portion of the adjunct.

In one embodiment, the first attachment mechanism can be at least onepost formed on one of the adjunct and the jaw, and at least one boreformed on the other one of the adjunct and the jaw for receiving thepost. In further aspects, a second attachment mechanism on the adjunctcan prevent sliding of the adjunct relative to the jaw having theadjunct disposed thereon. The second attachment mechanism on the adjunctcan prevent lateral sliding and/or longitudinal sliding of the adjunctrelative to a longitudinal axis of the jaw. In other aspects, a secondattachment mechanism on the adjunct can prevent curling of a distal-mostend of the adjunct when the tissue is positioned between the first andsecond jaws.

In another embodiment, a method for stapling tissue is provided andincludes positioning an adjunct on at least one jaw of first and secondjaws of an end effector of a surgical stapler. The adjunct can bemaintained on the at least one jaw in a first state in which the adjunctis at least partially stretched over the at least one jaw. The methodcan also include positioning tissue between the first and second jaws,and actuating the surgical stapler to cause the first and second jaws tomove from an open position to a closed position in which the tissue isengaged therebetween. Actuation of the surgical stapler can cause theadjunct to transition from the first state to a second state such thatthe adjunct in the second state at least partially separates from the atleast one jaw.

In certain embodiments, actuation of the surgical stapler can includecausing a cutting element of the surgical stapler to move to thereby cutthrough at least a portion of the adjunct to cause the adjunct totransition from the first state to the second state. The cutting elementcan cut through at least a portion of the attachment feature as thecutting element moves. In further embodiments, actuation of the surgicalstapler can cause staples to be deployed to thereby penetrate through atleast a portion of the adjunct to cause the adjunct to transition fromthe first state to the second state.

BRIEF DESCRIPTION OF DRAWINGS

This invention will be more fully understood from the following detaileddescription taken in conjunction with the accompanying drawings, inwhich:

FIG. 1 is a perspective view of one embodiment of a surgical stapler;

FIG. 2 is an exploded view of a distal portion of the surgical staplerof FIG. 1;

FIG. 3 is a perspective view of a firing bar of the surgical stapler ofFIG. 1;

FIG. 4 is a perspective view of another embodiment of a surgical staplerhaving a modular shaft;

FIG. 5 is a perspective view of an embodiment of a circular surgicalstapler;

FIG. 6 is a partially exploded view of an end effector including a pairof opposed jaws and a cartridge;

FIG. 7 is a perspective view of another embodiment of an end effectorhaving an anvil assembly coupled to a cartridge with an adjunct securedto the anvil assembly and an adjunct secured to the cartridge;

FIG. 8 is a cross-sectional view of one embodiment of an end effectorhaving an adjunct material secured to a cartridge with a suture thatextends around the cartridge;

FIG. 9A is a perspective view of another embodiment of an end effectorhaving an anvil assembly coupled to a cartridge with an adjunct securedto an anvil plate of the anvil assembly and an adjunct secured to thecartridge using at least one suture;

FIG. 9B is a top perspective view of a portion of the anvil plate ofFIG. 9A showing suture attachment points along the top surface of theanvil plate;

FIG. 9C is a bottom perspective view of a portion of the cartridge ofFIG. 9A showing the suture attachment points along the underside of thecartridge;

FIG. 10A is a perspective view of a portion of a cartridge having sutureattachment points on opposed sides of the cartridge according to anotherembodiment;

FIG. 10B is a perspective view of the portion of the cartridge of FIG.10A showing a pan coupled to the cartridge and positioned over thesuture attachment points;

FIG. 11 is a cross-sectional view of an anvil plate having anvil surfacefeatures that mate with upper jaw cavities along an upper jaw member ofan end effector according to yet another embodiment;

FIG. 12A is an exploded view of one embodiment of a frame configured tocouple to an adjunct material and a jaw;

FIG. 12B is a perspective top view of the frame coupled to the jaw ofFIG. 12A;

FIG. 13A is an exploded view of another embodiment of a frame configuredto couple to a jaw and an adjunct material;

FIG. 13B is a perspective top view of the frame coupled to the jaw ofFIG. 13A, with the adjunct material coupled to a tissue-facing surfaceof the frame;

FIG. 13C is a cross section view of the frame coupled to the jaw of FIG.13B, with the frame having a plurality of retaining features that securethe adjunct material to the tissue-facing surface of the frame;

FIG. 13D is a cross section view of the frame coupled to the jaw of FIG.13B;

FIG. 13E is an exploded view of the frame of FIG. 13A and the jawshowing an outward facing surface of the jaw having attachment armfeatures;

FIG. 14A is a perspective view of yet another embodiment of a frameconfigured as an overlay extending around a jaw with a tissue facingsurface of the overlay having two rows of retaining features;

FIG. 14B is a cross-sectional view of a portion of an end effector ofFIG. 14A showing a first overlay coupled to the jaw and a second overlaycoupled to another jaw with a first and second adjunct material,respectively, releasably coupled thereon;

FIG. 14C is a perspective view of an applicator member configured toapply the first and second adjunct materials to the first and secondoverlays of FIG. 14B;

FIG. 15 is a perspective, partial cutaway view of one embodiment of acartridge having an adjunct releasably retained thereon via a retainer;

FIG. 16 is a perspective, partial cutaway view of a portion of thecartridge and retainer of FIG. 15;

FIG. 17 is a side view of a portion of the cartridge, retainer, andadjunct of FIG. 15;

FIG. 18 is another side view of a portion of the cartridge, retainer,and adjunct of FIG. 15;

FIG. 19 is a perspective, partial cutaway view of another embodiment ofa cartridge having an adjunct releasably retained thereon via aretainer;

FIG. 20 is a perspective, partial cutaway view of yet another embodimentof a cartridge having an adjunct releasably retained thereon via aretainer;

FIG. 21 is another perspective, partial cutaway view of the cartridge,retainer, and adjunct of FIG. 20;

FIG. 22 is a side view of a portion of the cartridge and retainer ofFIG. 20;

FIG. 23 is a perspective, partial cutaway view of another embodiment ofa cartridge having an adjunct releasably retained thereon;

FIG. 24 is a side view of a portion of the cartridge and adjunct of FIG.23 pre-assembly;

FIG. 25 is a side view of the portion of the assembled cartridge andadjunct of FIG. 24;

FIG. 26 is a perspective view of an embodiment of an anvil and aretainer coupled thereto;

FIG. 27 is an exploded view of the anvil and retainer of FIG. 26;

FIG. 28 is a perspective view of a retaining element of the retainer ofFIG. 27;

FIG. 29 is a perspective view of another embodiment of an anvil and aretainer coupled thereto;

FIG. 30 is an exploded view of the anvil and retainer of FIG. 29;

FIG. 31 is a top view of a lower jaw member of a surgical staplershowing a portion of an adjunct disposed thereon;

FIG. 32 is a perspective view of a single staple driver with an adjunctreleasing mechanism;

FIG. 33 is a perspective view of a double staple driver with an adjunctreleasing mechanism;

FIG. 34 is a cross-sectional side view of another embodiment of aportion of a lower jaw member of a surgical stapler with an adjunctreleasing mechanism;

FIG. 35 is a perspective view of one embodiment of an end effector inaccordance with the described techniques;

FIG. 36 is a perspective view of the cartridge body of the end effectorof FIG. 35;

FIG. 37 is another perspective view of the cartridge body of the endeffector of FIG. 35;

FIG. 38 is a perspective view of the adjunct material releasablyretained on at least one jaw of the end effector of FIG. 35;

FIG. 39 is a top view of the end effector of FIG. 35, showing the jawsof the end effector in a closed position;

FIG. 40 is a perspective view of another embodiment of an end effectorin accordance with the described techniques;

FIG. 41 is a top view of the adjunct material releasably retained on theanvil of the end effector of FIG. 40;

FIG. 42 is a top view of the adjunct material releasably retained on thecartridge of the end effector of FIG. 40;

FIG. 43 is a perspective, partially cut-away view of one embodiment ofan anvil of an end effector in accordance with the described techniques;and

FIG. 44 is a side view of a portion of the anvil of FIG. 43.

FIG. 45 is a perspective view of a jaw of an end effector that has anadjunct material releasably secured thereto;

FIG. 46A is a perspective view an adjunct that has contractibleattachment features disposed on a jaw of an end effector before theadjunct is coupled to the jaw;

FIG. 46B is a perspective view of the adjunct of FIG. 47A, illustratingthe adjunct coupled to the jaw by application of heat;

FIG. 47A is another perspective view an adjunct that has contractibleattachment features disposed on a jaw of an end effector before theadjunct is coupled to the jaw;

FIG. 47B is a perspective view of the adjunct of FIG. 48A, illustratingthe adjunct coupled to the jaw by application of heat;

FIG. 48A is a top view of one embodiment of a loader;

FIG. 48B is a cross-sectional view of the loader of FIG. 49A;

FIG. 49A is a perspective view of a jaw and an adjunct configured to bereleasably coupled to the jaw;

FIG. 49B is a perspective view of the jaw of FIG. 50A, illustrating theadjunct releasably coupled to the jaw;

FIG. 50 is an exploded view of a jaw of an end effector and at leastpartially stretchable adjunct material configured to be releasablycoupled to the jaw;

FIG. 51 is a schematic view of the adjunct material of FIG. 51,illustrating areas of the adjunct material configured to havenon-stretchable portions;

FIG. 52A is a cross-sectional view of a jaw of an end effector and atleast partially stretchable adjunct material to be releasably coupled tothe jaw;

FIG. 52B is a cross-sectional view of the jaw of FIG. 53A, illustratingthe adjunct material releasably coupled to the jaw;

FIG. 53A is a cross-sectional view of jaws of an end effector and aloader prior to adjuncts being releasably coupled to the jaws;

FIG. 53B is a cross-sectional view of the jaws and the loader of FIG.54A, illustrating the jaws and the loader while the adjuncts are beingtransferred from the loader to the jaws;

FIG. 53C is a cross-sectional view of the jaws and the loader of FIG.54A, illustrating the jaws and the loader after the adjuncts have beentransferred from the loader to the jaws and are releasably coupled tothe jaws;

FIG. 54 is a perspective view of one embodiment of an adjunct coupled toan end effector jaw by suction;

FIG. 55A is a cross-sectional view of the end effector jaw and adjunctof FIG. 54 showing the adjunct prior to contact with a tissue contactingsurface of the jaw;

FIG. 55B is a cross-sectional view of the end effector jaw and adjunctof FIG. 55A showing the adjunct attached to the tissue contactingsurface of the jaw by suction;

FIG. 55C is a cross-sectional view of the end effector jaw and adjunctof FIG. 55A showing the adjunct punctured by staples;

FIG. 56A is a perspective view of another embodiment of an adjunctcoupled to an end effector jaw by suction;

FIG. 56B is a perspective disassembled view of a portion of the adjunctof FIG. 56A;

FIG. 57A is a cross-sectional view of the end effector jaw of FIG. 56Ashowing the adjunct prior to contact with a tissue contacting surface ofthe jaw;

FIG. 57B is a cross-sectional view of the end effector jaw and adjunctof FIG. 57A showing the adjunct attached to the tissue contactingsurface of the jaw by suction;

FIG. 57C is a cross-sectional view of the end effector jaw and adjunctof FIG. 57A showing the adjunct punctured by staples;

FIG. 58 is a perspective disassembled view of a portion of an adjunctaccording to another embodiment;

FIG. 59 is a perspective, partial cut-away view of a jaw of an endeffector having an adjunct material releasably mounted thereon inaccordance with the described techniques;

FIG. 60 is a cross-sectional view of a portion of the jaw of FIG. 59with the adjunct material;

FIG. 61 is a perspective view of a distal portion of an end effectorhaving an adjunct material releasably mounted thereon in accordance withthe described techniques;

FIG. 62A is a top view of a portion of an adjunct material having“non-retaining” female features used in accordance with the describedtechniques;

FIG. 62B is a top view of “non-retaining” male features that can beformed on a jaw for mating with the adjunct material of FIG. 62A, inaccordance with the described techniques;

FIG. 62C is a top view of the adjunct material of FIG. 62A having its“non-retaining” female features encompassing the “non-retaining” malefeatures of FIG. 62B;

FIG. 63 is a perspective, partial cut-away view of an adjunct materialhaving a backing layer in accordance with the described techniques;

FIG. 64 is a perspective, partial cut-away view of another adjunctmaterial having a backing layer in accordance with the describedtechniques;

FIG. 65 is a perspective, partially exploded view of a distal portion ofa jaw of an end effector and an adjunct material configured to bereleasably mounted on the jaw in accordance with the describedtechniques;

FIG. 66 is a bottom view of the adjunct material of FIG. 65,illustrating the adjunct material when it is retained at a treatmentsite in a patient;

FIG. 67A illustrates an example of an adjunct releasably retained to atissue facing surface of a surgical stapler device;

FIG. 67B illustrates a cross-sectional view of a tissue clamped betweenan upper jaw and a lower jaw of the surgical stapler device;

FIG. 67C illustrates a perspective view of an embodiment of a distal endof a firing bar of the surgical stapler device;

FIG. 68A is a side view of an embodiment of a jaw of an end effector,illustrating the jaw in a pre-fired configuration;

FIG. 68B is a side view of the jaw of FIG. 68A, illustrating the jaw ina fired configuration;

FIG. 69 illustrates a perspective view of an example of an adjunctremoval system;

FIG. 70 illustrates a top-down view of a jaw of an end effector;

FIG. 71 illustrates a perspective, partially cut-away view of the jaw ofthe end effector of FIG. 70;

FIG. 72 is a perspective view of one embodiment of an adjunct coupled toan end effector jaw by a hybrid attachment mechanism;

FIG. 73 is a cross-sectional view of the end effector jaw of FIG. 1,showing a portion of the adjunct of FIG. 72 coupled thereto;

FIG. 74 is another cross-sectional view of the end effector jaw of FIG.1, showing a portion of the adjunct of FIG. 72 coupled thereto;

FIG. 75 is a perspective view of another embodiment of an adjunctcoupled to an end effector jaw of FIG. 1;

FIG. 76 is another perspective view of another embodiment of an adjunctcoupled to an end effector jaw of FIG. 1;

FIG. 77 is perspective, exploded view of a jaw of an end effector and anadjunct material configured to be coupled to the jaw via a polymerlayer;

FIG. 78 is a cross-sectional view of a portion of the adjunct materialof FIG. 78 coupled to the jaw of the end effector via the polymer layer;

FIG. 79 is a top view of an adjunct loading member;

FIG. 80 is a cross-sectional view of the adjunct loading member of FIG.79;

FIG. 81A is a cross-sectional view of an adjunct loading memberconfigured to apply an adjunct material to first and second jaws of anend effector;

FIG. 81B is a cross-sectional view of the adjunct loading member of FIG.81A, illustrating the adjunct material applied to the first and secondjaws of the end effector;

FIG. 82 is a perspective view of an adjunct loading member;

FIG. 83A is a cross-sectional view of a portion of an adjunct loadingmember configured to apply an adjunct material to a jaw of an endeffector using a curable adhesive;

FIG. 83B is a cross-sectional view of the adjunct loading member of FIG.83A, illustrating the adjunct loading member when load is appliedthereto;

FIG. 83C is a cross-sectional view of the adjunct loading member of FIG.83A, illustrating the adjunct loading member when load is appliedthereto and the adhesive is being cured;

FIG. 84A is a cross-sectional view of a portion of an adjunct loadingmember configured to apply an adjunct material to first and second jawsof an end effector using a curable adhesive;

FIG. 84B is a cross-sectional view of the adjunct loading member of FIG.84A, illustrating the adjunct loading member when load is appliedthereto;

FIG. 85 is a perspective view of an adjunct loading member;

FIG. 86A is a cross-sectional view of a portion of an adjunct materialreleasably coupled to a first jaw of an end effector using an adhesive;

FIG. 86B is a cross-sectional view of the adjunct material of FIG. 86A,illustrating staples fired from a second jaw of the end effector and theend effector causing the adhesive to break;

FIG. 86C is a cross-sectional view of the adjunct material of FIG. 86A,illustrating the adjunct material separated from the end effector;

FIG. 87 is a perspective view of one embodiment of an adjunct loader foruse with a surgical stapler;

FIG. 88 is a top view of the adjunct loader of FIG. 87;

FIG. 89 is a cross-sectional side view of the adjunct loader of FIG. 87;

FIG. 90 is a perspective view of another embodiment of an adjunct loaderfor use with a surgical stapler;

FIG. 91 is a top view of the adjunct loader of FIG. 90;

FIG. 92 is a cross-sectional side view of the adjunct loader of FIG. 90;

FIG. 93 is a cross-sectional side view of another embodiment of anadjunct loader for use with a surgical stapler;

FIG. 94 is a cross-sectional side view of the adjunct loader of FIG. 93;

FIG. 95 is a cross-sectional side view of another embodiment of anadjunct loader for use with a surgical stapler;

FIG. 96 is a cross-sectional view of the adjunct loader of FIG. 95;

FIG. 97 is a perspective view of a jaw of an end effector having anadjunct material releasably mounted thereon using an attachment featurein accordance with the described techniques;

FIG. 98 is a perspective partial view of the jaw with the adjunctmaterial of FIG. 97;

FIG. 99 is a perspective view of a side of the jaw of FIG. 97 that isopposed to a tissue-contacting side thereof, illustrating end featuresof the attachment feature;

FIG. 100 is another perspective view of a jaw of an end effector havingan adjunct material releasably mounted thereon using an attachmentfeature in accordance with the described techniques;

FIG. 101 is a schematic diagram illustrating an example of a roughnessportion that can be formed on the jaw of FIG. 97 and the jaw of FIG.100;

FIG. 102 is a perspective view of an upper side of a jaw of an endeffector having an adjunct material releasably mounted thereon using aspindle-type attachment feature in accordance with the describedtechniques;

FIG. 103 is a perspective view of a jaw of an end effector configured toreleasably retain thereon an adjunct material using an attachmentfeature in accordance with the described techniques;

FIG. 104 is a perspective, partially transparent view of the jaw of FIG.103, illustrating the attachment feature releasably retaining theadjunct material on the jaw;

FIG. 105 is a perspective view of a jaw of an end effector configured toreleasably retain thereon first and second adjunct materials;

FIG. 106 is a perspective view of the jaw of FIG. 105, illustrating thefirst and second adjunct materials releasably retained on the jaw;

FIG. 107 is another perspective view of a jaw of an end effectorconfigured to releasably retain thereon first and second adjunctmaterials;

FIG. 108 is a perspective view of a portion of the first and secondadjunct materials of FIG. 16, illustrating a tab in one of the adjunctmaterials engaging with a slot in another one of the adjunct materials;

FIG. 109 is a perspective view of a jaw of an end effector configured toreleasably retain thereon an adjunct material;

FIG. 110A is a schematic diagram illustrating a portion of the adjunctmaterial of FIG. 109;

FIG. 110B is a schematic diagram illustrating the portion of the adjunctmaterial of FIG. 110A in engagement with a portion of the jaw of FIG.109;

FIG. 111 is a perspective, partially exploded view of an end effectorhaving an adjunct material releasably mounted thereon in accordance withthe described techniques;

FIG. 112 is a partially exploded side view of the end effector of FIG.111;

FIG. 113A is a cross-sectional view of a portion of the adjunct materialand a polymer layer material of FIG. 112;

FIG. 113B is a cross-sectional view of a portion of the end effector ofFIG. 112 having the adjunct material with the polymer layer materialreleasably retained thereon;

FIG. 114 is a perspective view of an end effector having an adjunctmaterial releasably mounted thereon in accordance with the describedtechniques;

FIG. 115 is a perspective view of an applicator member configured toapply the adjunct material to the end effector of FIG. 114;

FIG. 116 is a cross-sectional view of a portion of the end effector ofFIG. 114 having the adjunct material releasably retained thereon;

FIG. 117 is a perspective, partially exploded view of an end effectorhaving first and second adjunct materials releasably mounted thereon inaccordance with the described techniques;

FIG. 118 is a perspective, partially exploded view of the end effectorof FIG. 117, illustrating the first and second adjunct materials appliedto a tissue in a patient;

FIG. 119 is a perspective view of an applicator member configured toapply the first and second adjunct materials to the end effector of FIG.117;

FIG. 120 is a perspective, schematic view of a jaw of an end effectorhaving recesses formed thereon that are configured to mate with portionsof an adjunct material in accordance with the described techniques;

FIG. 121 is a perspective, schematic view of the jaw of FIG. 120 and ofan applicator member configured to cause the portions of the adjunctmaterial to be received in the recesses in the jaw;

FIG. 122 is a perspective, schematic view of the jaw of FIG. 120,illustrating the portions of the adjunct material received in therecesses in the jaw using the applicator member;

FIG. 123 is a perspective view of an end effector having an adjunctmaterial releasably mounted thereon in accordance with the describedtechniques;

FIG. 124 is a cross-sectional view of a portion of the end effector ofFIG. 123 having the adjunct material releasably retained thereon;

FIG. 125 is a perspective view of an end effector having an adjunctmaterial releasably mounted thereon in accordance with the describedtechniques;

FIG. 126 is a perspective view of an applicator member configured toapply the adjunct material to the end effector of FIG. 125;

FIG. 127 is a cross-sectional view of a portion of the end effector ofFIG. 125 having the adjunct material releasably retained thereon;

FIG. 128A is a perspective view of one embodiment of an applicatordelivering a flowable adjunct precursor to a tissue;

FIG. 128B is a perspective view of another embodiment of an applicatordelivering a flowable adjunct precursor to a tissue;

FIG. 128C is a perspective view of a mesh employed in combination with aflowable adjunct precursor delivered to a tissue;

FIG. 128D is a perspective view of a stapler engaging tissue having anadjunct formed from any of the adjunct precursor of FIGS. 128A-128C;

FIG. 128E is a perspective view illustrating the tissue and adjunct ofFIG. 128D after delivery of a plurality of staples therethrough and thetissue is cut through the adjunct;

FIG. 129A is an expanded perspective view of another embodiment of anadjunct and a portion of an end effector of an adjunct delivery deviceconfigured to deliver the adjunct to a tissue treatment site;

FIG. 129B is a perspective view of a tissue after deposition of theadjunct thereon by the adjunct delivery device of FIG. 129A;

FIG. 130A is a perspective view of one embodiment of a stapler engagingthe tissue and adjunct of FIG. 129B;

FIG. 130B is a perspective view of the tissue and adjunct of FIG. 129Bafter delivery of a plurality of staples therethrough;

FIG. 131A is a perspective view of a tissue and an alternativeembodiment of an adjunct including a plurality of lateral flangesconfigured to guide a stapler with respect to the adjunct;

FIG. 131B is a perspective view of a stapler engaging the adjunct andthe tissue of FIG. 131A;

FIG. 131C is a perspective view the adjunct and tissue of FIG. 8B afterdelivery of the plurality of staples therethrough and the tissue is cutthrough the adjunct;

FIG. 132A is an expanded perspective view of another embodiment of anadjunct system configured for use with a surgical stapler; and

FIG. 132B is a perspective view of the adjunct system of FIG. 132Apositioned on a tissue after delivery of a plurality of staplestherethrough and the tissue is cut through the adjunct system.

DETAILED DESCRIPTION

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the devices and methods disclosed herein. One ormore examples of these embodiments are illustrated in the accompanyingdrawings. Those skilled in the art will understand that the devices,systems, and methods specifically described herein and illustrated inthe accompanying drawings are non-limiting exemplary embodiments andthat the scope of the present invention is defined solely by the claims.The features illustrated or described in connection with one exemplaryembodiment may be combined with the features of other embodiments. Suchmodifications and variations are intended to be included within thescope of the present invention.

Further, in the present disclosure, like-named components of theembodiments generally have similar features, and thus within aparticular embodiment each feature of each like-named component is notnecessarily fully elaborated upon. Additionally, to the extent thatlinear or circular dimensions are used in the description of thedisclosed systems, devices, and methods, such dimensions are notintended to limit the types of shapes that can be used in conjunctionwith such systems, devices, and methods. A person skilled in the artwill recognize that an equivalent to such linear and circular dimensionscan easily be determined for any geometric shape. Sizes and shapes ofthe systems and devices, and the components thereof, can depend at leaston the anatomy of the subject in which the systems and devices will beused, the size and shape of components with which the systems anddevices will be used, and the methods and procedures in which thesystems and devices will be used.

It can be desirable to use one or more biologic materials and/orsynthetic materials, collectively referred to herein as “adjuncts” or“buttresses,” in conjunction with surgical instruments to help improvesurgical procedures. While a variety of different surgical end effectorscan benefit from the use of adjuncts, in some exemplary embodiments theinstrument can be a surgical stapler. When used in conjunction with asurgical stapler, the adjunct(s) can be disposed between and/or on jawsof the stapler, incorporated into a staple cartridge disposed in thejaws, or otherwise placed in proximity to the staples. When staples aredeployed, the adjunct(s) can remain at the treatment site with thestaples, in turn providing a number of benefits. For example, theadjunct(s) may reinforce tissue at the treatment site, preventingtearing or ripping by the staples at the treatment site. Tissuereinforcement may be needed to keep the staples from tearing through thetissue if the tissue is diseased, is healing from another treatment suchas irradiation, medications such as chemotherapy, or other tissueproperty altering situation. In some instances, the adjunct(s) mayminimize tissue movement in and around the staple puncture sites thatcan occur from tissue deformation that occurs after stapling (e.g., lunginflation, gastrointestinal tract distension, etc.). It will berecognized by one skilled in the art that a staple puncture site mayserve as a stress concentration and that the size of the hole created bythe staple will grow when the tissue around it is placed under tension.Restricting the tissues movement around these puncture sites canminimize the size the holes may grow to under tension. In someinstances, the adjunct(s) can be configured to wick or absorb beneficialfluids, e.g., sealants, blood, glues, that further promote healing, andin some instances, the adjunct(s) can be configured to degrade to form agel, e.g., a sealant, that further promotes healing. In some instances,the adjunct(s) can be used to help seal holes formed by staples as theyare implanted into tissue, blood vessels, and various other objects orbody parts. The adjunct(s) may also affect tissue growth through thespacing, positioning and/or orientation of any fibers or strandsassociated with the adjunct(s). Furthermore, in some circumstances, anadjunct can be useful in distributing pressure applied by the staplethereby reducing the possibility of a staple pulling through a tissue(which can be friable) and failing to fasten the tissue as intended(so-called “cheese wiring”). Additionally, the adjunct can be at leastpartially stretchable and can thus allow at least partial natural motionof the tissue (e.g., expansion and contraction of lung tissue duringbreathing). In some embodiments, a staple line can be flexible asdescribed, for example, in U.S. Pat. Pub. No. 2016/0089142 entitled“Method for Creating a Flexible Staple Line,” filed on Sep. 26, 2014,which is hereby incorporated by reference herein in its entirety.

Coupling an adjunct material to one or both jaws of an end effector canbe tedious and time consuming for a user, which can undesirably prolongsurgical procedures. Furthermore, surgical procedures can be prolongedwhen more than one adjunct material is applied to a jaw, such as forconsecutive stapling with an adjunct material. As such, various adjunctframe embodiments are described herein that are configured to releasablyattach an adjunct material thereto and to efficiently couple to a jaw ofan end effector of a surgical instrument. The adjunct frames can thusprovide an efficient way to couple an adjunct material to a jaw. Theadjunct frames are also configured to release the adjunct material whendesired, such as after the adjunct material has been cut by a knife ofthe end effector and/or after firing of staples by the end effector. Theadjunct frames can release the adjunct material while maintainingcoupling between the adjunct frame and the respective jaw. This canensure that the frame is not left at the surgical site, which wouldrequire additional procedure time to retrieve the frame and could resultin complications. Instead, the user can retract the end effector withthe adjunct frame still attached, thereby allowing the user to reloadthe adjunct frame with another adjunct material or decouple the adjunctframe from the jaw.

Surgical Stapling Instruments

A variety of surgical instruments can be used in conjunction with theadjunct(s) and/or medicant(s) disclosed herein. “Adjuncts” are alsoreferred to herein as “adjunct materials.” The surgical instruments caninclude surgical staplers. A variety of surgical staplers can be used,for example linear surgical staplers and circular staplers. In general,a linear stapler can be configured to create longitudinal staple linesand can include elongate jaws with a cartridge coupled theretocontaining longitudinal staple rows. The elongate jaws can include aknife or other cutting element capable of creating a cut between thestaple rows along tissue held within the jaws. In general, a circularstapler can be configured to create annular staple lines and can includecircular jaws with a cartridge containing annular staple rows. Thecircular jaws can include a knife or other cutting element capable ofcreating a cut inside of the rows of staples to define an openingthrough tissue held within the jaws. The staplers can be used in avariety of tissues in a variety of different surgical procedures, forexample in thoracic surgery or in gastric surgery.

FIG. 1 illustrates one example of a linear surgical stapler 10 suitablefor use with one or more adjunct(s) and/or medicant(s). The stapler 10generally includes a handle assembly 12, a shaft 14 extending distallyfrom a distal end 12 d of the handle assembly 12, and an end effector 30at a distal end 14 d of the shaft 14. The end effector 30 has opposedlower and upper jaws 32, 34, although other types of end effectors canbe used with the shaft 14, handle assembly 12, and components associatedwith the same. As shown in FIG. 2, the lower jaw 32 has a staple channel56 (see FIG. 2) configured to support a staple cartridge 40, and theupper jaw 34 has an anvil surface 33 that faces the lower jaw 32 andthat is configured to operate as an anvil to help deploy staples of thestaple cartridge 40 (the staples are obscured in FIGS. 1 and 2). Atleast one of the opposed lower and upper jaws 32, 34 is moveablerelative to the other lower and upper jaws 32, 34 to clamp tissue and/orother objects disposed therebetween. In some implementations, one of theopposed lower and upper jaws 32, 34 may be fixed or otherwise immovable.In some implementations, both of the opposed lower and upper jaws 32, 34may be movable. Components of a firing system can be configured to passthrough at least a portion of the end effector 30 to eject the staplesinto the clamped tissue. In various implementations a knife blade 36(see FIG. 3) or other cutting element can be associated with the firingsystem to cut tissue during the stapling procedure. The cutting elementcan be configured to cut tissue at least partially simultaneously withthe staples being ejected. In some circumstances, it may be advantageousif the tissue is cut after the staples have been ejected and the tissueis secured. Thus, if a surgical procedure requires that a tissuecaptured between the jaws be severed, the knife blade 36 is advanced tosever the tissue grasped between the jaws after the staples have beenejected from the staple cartridge 40.

Operation of the end effector 30 can begin with input from a user, e.g.,a clinician, a surgeon, etc., at the handle assembly 12. The handleassembly 12 can have many different configurations designed tomanipulate and operate the end effector 30 associated therewith. In theillustrated example, the handle assembly 12 has a pistol-grip typehousing 18 with a variety of mechanical and/or electrical componentsdisposed therein to operate various features of the instrument 10. Forexample, the handle assembly 12 can include a rotation knob 26 mountedadjacent the distal end 12 d thereof which can facilitate rotation ofthe shaft 14 and/or the end effector 30 with respect to the handleassembly 12 about a longitudinal axis L of the shaft 14. The handleassembly 12 can further include clamping components as part of aclamping system actuated by a clamping trigger 22 and firing componentsas part of the firing system that are actuated by a firing trigger 24.The clamping and firing triggers 22, 24 can be biased to an openposition with respect to a stationary handle 20, for instance by atorsion spring. Movement of the clamping trigger 22 toward thestationary handle 20 can actuate the clamping system, described below,which can cause the jaws 32, 34 to collapse towards each other and tothereby clamp tissue therebetween. Movement of the firing trigger 24 canactuate the firing system, described below, which can cause the ejectionof staples from the staple cartridge 40 disposed therein and/or theadvancement the knife blade 36 to sever tissue captured between the jaws32, 34. A person skilled in the art will recognize that variousconfigurations of components for a firing system, mechanical, hydraulic,pneumatic, electromechanical, robotic, or otherwise, can be used toeject staples and/or cut tissue.

As shown in FIG. 2, the end effector 30 of the illustratedimplementation has the lower jaw 32 that serves as a cartridge assemblyor carrier and the opposed upper jaw 34 that serves as an anvil. Thestaple cartridge 40, having a plurality of staples therein, is supportedin a staple tray 37, which in turn is supported within a cartridgechannel of the lower jaw 32. The upper jaw 34 has a plurality of stapleforming pockets (not shown), each of which is positioned above acorresponding staple from the plurality of staples contained within thestaple cartridge 40. The upper jaw 34 can be connected to the lower jaw32 in a variety of ways, although in the illustrated implementation theupper jaw 34 has a proximal pivoting end 34 p that is pivotally receivedwithin a proximal end 56 p of the staple channel 56, just distal to itsengagement to the shaft 14. When the upper jaw 34 is pivoted downwardly,the upper jaw 34 moves the anvil surface 33 and the staple formingpockets formed thereon move toward the opposing staple cartridge 40.

Various clamping components can be used to effect opening and closing ofthe jaws 32, 34 to selectively clamp tissue therebetween. Asillustrated, the pivoting end 34 p of the upper jaw 34 includes aclosure feature 34 c distal to its pivotal attachment with the staplechannel 56. Thus, a closure tube 46, whose distal end includes ahorseshoe aperture 46 a that engages the closure feature 34 c,selectively imparts an opening motion to the upper jaw 34 duringproximal longitudinal motion and a closing motion to the upper jaw 34during distal longitudinal motion of the closure tube 46 in response tothe clamping trigger 22. As mentioned above, in various implementations,the opening and closure of the end effector 30 may be effected byrelative motion of the lower jaw 32 with respect to the upper jaw 34,relative motion of the upper jaw 34 with respect to the lower jaw 32, orby motion of both jaws 32, 34 with respect to one another.

The firing components of the illustrated implementation includes afiring bar 35, as shown in FIG. 3, having an E-beam 38 on a distal endthereof. The firing bar 35 is encompassed within the shaft 14, forexample in a longitudinal firing bar slot 14 s of the shaft 14, andguided by a firing motion from the handle 12. Actuation of the firingtrigger 24 can affect distal motion of the E-beam 38 through at least aportion of the end effector 30 to thereby cause the firing of staplescontained within the staple cartridge 40. As illustrated, guides 39projecting from a distal end of the E-Beam 38 can engage a wedge sled47, shown in FIG. 2, which in turn can push staple drivers 48 upwardlythrough staple cavities 41 formed in the staple cartridge 40. Upwardmovement of the staple drivers 48 applies an upward force on each of theplurality of staples within the cartridge 40 to thereby push the staplesupwardly against the anvil surface 33 of the upper jaw 34 and createformed staples.

In addition to causing the firing of staples, the E-beam 38 can beconfigured to facilitate closure of the jaws 32, 34, spacing of theupper jaw 34 from the staple cartridge 40, and/or severing of tissuecaptured between the jaws 32, 34. In particular, a pair of top pins anda pair of bottom pins can engage one or both of the upper and lower jaws32, 34 to compress the jaws 32, 34 toward one another as the firing bar35 advances through the end effector 30. Simultaneously, the knife 36extending between the top and bottom pins can be configured to severtissue captured between the jaws 32, 34.

In use, the surgical stapler 10 can be disposed in a cannula or port anddisposed at a surgical site. A tissue to be cut and stapled can beplaced between the jaws 32, 34 of the surgical stapler 10. Features ofthe stapler 10 can be maneuvered as desired by the user to achieve adesired location of the jaws 32, 34 at the surgical site and the tissuewith respect to the jaws 32, 34. After appropriate positioning has beenachieved, the clamping trigger 22 can be pulled toward the stationaryhandle 20 to actuate the clamping system. The clamping trigger 22 cancause components of the clamping system to operate such that the closuretube 46 advances distally through at least a portion of the shaft 14 tocause at least one of the jaws 32, 34 to collapse towards the other toclamp the tissue disposed therebetween. Thereafter, the firing trigger24 can be pulled toward the stationary handle 20 to cause components ofthe firing system to operate such that the firing bar 35 and/or theE-beam 38 are advanced distally through at least a portion of the endeffector 30 to effect the firing of staples and optionally to sever thetissue captured between the jaws 32, 34.

Another example of a surgical instrument in the form of a linearsurgical stapler 50 is illustrated in FIG. 4. The stapler 50 cangenerally be configured and used similar to the stapler 10 of FIG. 1.Similar to the surgical instrument 10 of FIG. 1, the surgical instrument50 includes a handle assembly 52 with a shaft 54 extending distallytherefrom and having an end effector 60 on a distal end thereof fortreating tissue. Upper and lower jaws 64, 62 of the end effector 60 canbe configured to capture tissue therebetween, staple the tissue byfiring of staples from a cartridge 66 disposed in the lower jaw 62,and/or to create an incision in the tissue. In this implementation, anattachment portion 67 on a proximal end of the shaft 54 can beconfigured to allow for removable attachment of the shaft 54 and the endeffector 60 to the handle assembly 52. In particular, mating features 68of the attachment portion 67 can mate to complementary mating features71 of the handle assembly 52. The mating features 68, 71 can beconfigured to couple together via, e.g., a snap fit coupling, a bayonettype coupling, etc., although any number of complementary matingfeatures and any type of coupling can be used to removably couple theshaft 54 to the handle assembly 52. Although the entire shaft 54 of theillustrated implementation is configured to be detachable from thehandle assembly 52, in some implementations, the attachment portion 67can be configured to allow for detachment of only a distal portion ofthe shaft 54. Detachable coupling of the shaft 54 and/or the endeffector 60 can allow for selective attachment of a desired end effector60 for a particular procedure, and/or for reuse of the handle assembly52 for multiple different procedures.

The handle assembly 52 can have one or more features thereon tomanipulate and operate the end effector 60. By way of non-limitingexample, a rotation knob 72 mounted on a distal end of the handleassembly 52 can facilitate rotation of the shaft 54 and/or the endeffector 60 with respect to the handle assembly 52. The handle assembly52 can include clamping components as part of a clamping system actuatedby a movable trigger 74 and firing components as part of a firing systemthat can also be actuated by the trigger 74. Thus, in someimplementations, movement of the trigger 74 toward a stationary handle70 through a first range of motion can actuate clamping components tocause the opposed jaws 62, 64 to approximate toward one another to aclosed position. In some implementations, only one of the opposed jaws62, 24 can move to move the jaws 62, 64 to the closed position. Furthermovement of the trigger 74 toward the stationary handle 70 through asecond range of motion can actuate firing components to cause theejection of the staples from the staple cartridge 66 and/or theadvancement of a knife or other cutting element (not shown) to severtissue captured between the jaws 62, 64.

One example of a surgical instrument in the form of a circular surgicalstapler 80 is illustrated in FIG. 5. The stapler 80 can generally beconfigured and used similar to the linear staplers 10, 50 of FIGS. 1 and4, but with some features accommodating its functionality as a circularstapler. Similar to the surgical instruments 10, 50, the surgicalinstrument 80 includes a handle assembly 82 with a shaft 84 extendingdistally therefrom and having an end effector 90 on a distal end thereoffor treating tissue. The end effector 90 can include a cartridgeassembly 92 and an anvil 94, each having a tissue-contacting surfacethat is substantially circular in shape. The cartridge assembly 92 andthe anvil 94 can be coupled together via a shaft 98 extending from theanvil 94 to the handle assembly 82 of the stapler 80, and manipulatingan actuator 85 on the handle assembly 82 can retract and advance theshaft 98 to move the anvil 94 relative to the cartridge assembly 92. Theanvil 94 and cartridge assembly 92 can perform various functions and canbe configured to capture tissue therebetween, staple the tissue byfiring of staples from a cartridge 96 of the cartridge assembly 92and/or can create an incision in the tissue. In general, the cartridgeassembly 92 can house a cartridge containing the staples and can deploystaples against the anvil 94 to form a circular pattern of staples,e.g., staple around a circumference of a tubular body organ.

In one implementation, the shaft 98 can be formed of first and secondportions (not shown) configured to releasably couple together to allowthe anvil 94 to be detached from the cartridge assembly 92, which mayallow greater flexibility in positioning the anvil 94 and the cartridgeassembly 92 in a body of a patient. For example, the first portion ofthe shaft 98 can be disposed within the cartridge assembly 92 and extenddistally outside of the cartridge assembly 92, terminating in a distalmating feature. The second portion of the shaft 98 can be disposedwithin the anvil 94 and extend proximally outside of the cartridgeassembly 92, terminating in a proximal mating feature. In use, theproximal and distal mating features can be coupled together to allow theanvil 94 and cartridge assembly 92 to move relative to one another.

The handle assembly 82 of the stapler 80 can have various actuatorsdisposed thereon that can control movement of the stapler. For example,the handle assembly 82 can have a rotation knob 86 disposed thereon tofacilitate positioning of the end effector 90 via rotation, and/or thetrigger 85 for actuation of the end effector 90. Movement of the trigger85 toward a stationary handle 87 through a first range of motion canactuate components of a clamping system to approximate the jaws, i.e.move the anvil 94 toward the cartridge assembly 92. Movement of thetrigger 85 toward the stationary handle 87 through a second range ofmotion can actuate components of a firing system to cause the staples todeploy from the staple cartridge assembly 92 and/or cause advancement ofa knife to sever tissue captured between the cartridge assembly 92 andthe anvil 94.

The illustrated examples of surgical stapling instruments 10, 50, 80provide only a few examples of many different configurations, andassociated methods of use, that can be used in conjunction with thedisclosures provided herein. Although the illustrated examples are allconfigured for use in minimally invasive procedures, it will beappreciated that instruments configured for use in open surgicalprocedures, e.g., open linear staplers as described in U.S. Pat. No.8,317,070 entitled “Surgical Stapling Devices That Produce FormedStaples Having Different Lengths” and filed Feb. 28, 2007, can be usedin conjunction with the disclosures provided herein. Greater detail onthe illustrated examples, as well as additional examples of surgicalstaplers, components thereof, and their related methods of use, areprovided in U.S. Pat. Pub. No. 2015/0277471 entitled “Systems AndMethods For Controlling A Segmented Circuit” and filed Mar. 26, 2014,U.S. Pat. Pub. No. 2013/0256377 entitled “Layer Comprising DeployableAttachment Members” and filed Feb. 8, 2013, U.S. Pat. No. 8,393,514entitled “Selectively Orientable Implantable Fastener Cartridge” andfiled Sep. 30, 2010, U.S. Pat. No. 8,317,070 entitled “Surgical StaplingDevices That Produce Formed Staples Having Different Lengths” and filedFeb. 28, 2007, U.S. Pat. No. 7,143,925 entitled “Surgical InstrumentIncorporating EAP Blocking Lockout Mechanism” and filed Jun. 21, 2005,U.S. Pat. Pub. No. 2015/0134077 entitled “Sealing Materials For Use InSurgical Stapling” and filed Nov. 8, 2013, entitled “Sealing Materialsfor Use in Surgical Procedures, and filed on Nov. 8, 2013, U.S. Pat.Pub. No. 2015/0134076, entitled “Hybrid Adjunct Materials for Use inSurgical Stapling,” and filed on Nov. 8, 2013, U.S. Pat. Pub. No.2015/0133996, entitled “Positively Charged Implantable Materials andMethod of Forming the Same,” and filed on Nov. 8, 2013, U.S. Pat. Pub.No. 2015/0129634, entitled “Tissue Ingrowth Materials and Method ofUsing the Same,” and filed on Nov. 8, 2013, U.S. Pat. Pub. No.2015/0133995, entitled “Hybrid Adjunct Materials for Use in SurgicalStapling,” and filed on Nov. 8, 2013, U.S. Pat. Pub. No. 2015/0272575,entitled “Surgical Instrument Comprising a Sensor System,” and filed onMar. 26, 2014, and U.S. Pat. Pub. No. 2015/0351758, entitled “AdjunctMaterials and Methods of Using Same in Surgical Methods for TissueSealing,” and filed on Jun. 10, 2014, which are hereby incorporated byreference herein in their entireties.

Implantable Adjuncts

As indicated above, various implantable adjuncts are provided for use inconjunction with surgical stapling instruments. The adjuncts can have avariety of configurations, and can be formed from various materials. Ingeneral, an adjunct can be formed from one or more of a film, a foam, aninjection molded thermoplastic, a vacuum thermoformed material, afibrous structure, and hybrids thereof. The adjunct can also include oneor more biologically-derived materials and one or more drugs. Each ofthese materials is discussed in more detail below.

An adjunct can be formed from a foam, such as a closed-cell foam, anopen-cell foam, or a sponge. An example of how such an adjunct can befabricated is from animal derived collagen, such as porcine tendon, thatcan then be processed and lyophilized into a foam structure. Gelatin canalso be used and processed into a foam. Examples of various foamadjuncts are further described in previously mentioned U.S. Pat. No.8,393,514 entitled “Selectively Orientable Implantable FastenerCartridge” and filed Sep. 30, 2010.

An adjunct can also be formed from a film formed from any suitablematerial or combination thereof discussed below. The film can includeone or more layers, each of which can have different degradation rates.Furthermore, the film can have various regions formed therein, forexample, reservoirs that can releasably retain therein one or moremedicants in a number of different forms. The reservoirs having at leastone medicant disposed therein can be sealed using one or more differentcoating layers which can include absorbable or non-absorbable polymers.The film can be formed in various ways. For example, it can be anextruded or a compression molded film. The medicants can also beabsorbed onto the film or bound to the film via non-covalentinteractions such as hydrogen bonding.

An adjunct can also be formed from injection molded thermoplastic or avacuum thermoformed material. Examples of various molded adjuncts arefurther described in U.S. Pat. Pub. No. 2013/0221065 entitled “FastenerCartridge Comprising A Releasably Attached Tissue Thickness Compensator”and filed Feb. 8, 2013, which is hereby incorporated by reference in itsentirety. The adjunct can also be a fiber-based lattice which can be awoven fabric, knitted fabric or non-woven fabric such as a melt-blown,needle-punched or thermal-constructed loose woven fabric. An adjunct canhave multiple regions that can be formed from the same type of latticeor from different types of lattices that can together form the adjunctin a number of different ways. For example, the fibers can be woven,braided, knitted, or otherwise interconnected so as to form a regular orirregular structure. The fibers can be interconnected such that theresulting adjunct is relatively loose. Alternatively, the adjunct caninclude tightly interconnected fibers. The adjunct can be in a form of asheet, tube, spiral, or any other structure that can include compliantportions and/or more rigid, reinforcement portions. The adjunct can beconfigured such that certain regions thereof can have more dense fiberswhile others have less dense fibers. The fiber density can vary indifferent directions along one or more dimensions of the adjunct, basedon an intended application of the adjunct.

The adjunct can be formed from woven, knitted, or otherwiseinterconnected fibers, which allows the adjunct to be stretched. Forexample, the adjunct can be configured to stretch in a direction alongits longitudinal axis and/or in a lateral direction that isperpendicular to the longitudinal axis. While being stretchable in atleast two dimensions (e.g., X and Y directions), the adjunct can providereinforcement along its thickness (e.g., a Z direction) such that itstretches but resists tearing and pull-through by the staples.Non-limiting examples of adjuncts that are configured to be implantedsuch that they can stretch with the tissue are described in theabove-mentioned U.S. Pat. Pub. No. 2016/0089142 entitled “Method forCreating a Flexible Staple Line,” filed on Sep. 26, 2014, which ishereby incorporated by reference herein in its entirety.

The adjunct can also be a hybrid construct, such as a laminate compositeor melt-locked interconnected fiber. Examples of various hybridconstruct adjuncts are further described in U.S. Pat. No. 9,282,962entitled “Adhesive Film Laminate” and filed Feb. 8, 2013, and in U.S.Pat. No. 7,601,118 entitled “Minimally Invasive Medical Implant AndInsertion Device And Method For Using The Same” and filed Sep. 12, 2007,which are hereby incorporated by reference in their entireties.

The adjuncts in accordance with the described techniques can be formedfrom various materials. The materials can be used in various embodimentsfor different purposes. The materials can be selected in accordance witha desired therapy to be delivered to tissue so as to facilitate tissuein-growth. The materials can include bioabsorbable and biocompatiblepolymers, including homopolymers and copolymers. Bioabsorbable polymerscan be absorbable, resorbable, bioresorbable, or biodegradable polymers.

An adjunct can also include active agents, such as active cell culture(e.g., diced autologous tissue, agents used for stem cell therapy (e.g.,Biosutures and Cellerix S.L.), hemostatic agents, and tissue healingagents.

The adjuncts can releasably retain therein at least one medicant thatcan be selected from a large number of different medicants. Medicantsinclude, but are not limited to, drugs or other agents included within,or associated with, the adjunct that have a desired functionality. Themedicants include, but are not limited to, for example, antimicrobialagents such as antibacterial and antibiotic agents, antifungal agents,antiviral agents, anti-inflammatory agents, growth factors, analgesics,anesthetics, tissue matrix degeneration inhibitors, anti-cancer agents,hemostatic agents, and other agents that elicit a biological response.The adjuncts can also be made from or include agents that enhancevisibility during imaging, such as, for example, echogenic materials orradio-opaque materials.

Examples of various adjuncts and various techniques for releasingmedicants from adjuncts are further described in U.S. patent applicationSer. No. 14/840,613 entitled “Medicant Eluting Adjuncts and Methods ofUsing Medicant Eluting Adjuncts” and filed Aug. 31, 2015, which ishereby incorporated by reference in its entirety.

Surgical End Effector Adjunct Attachment

Various exemplary devices, systems and methods for releasably retainingan adjunct material on an end effector of a surgical instrument aredescribed herein. In a typical surgical stapler end effector, the anvilhas a preconfigured set of staple pockets formed therein and configuredto receive and form staples fired from the cartridge. As a result, theend effector can only be used with staple cartridges having staplecavities that align with the anvil. Accordingly, in an exemplaryembodiment, various anvil plates are provided having varying staplepocket configurations for use with different staple cartridges. Theanvil plate can mate to the upper jaw of an end effector, and acartridge designed for use with that particular anvil plate can beinserted into the lower jaw of the end effector. As such, the endeffector can create a variety of staple configurations by switching outthe anvil assembly and/or cartridge. Furthermore, adjunct materials canbe releasably secured to either the cartridge or anvil plate using oneor more restraining elements. For example, the adjunct materials can bepre-attached to the anvil plate and/or the cartridge (e.g., duringmanufacturing) and can be released from the anvil plate and/or cartridgeduring firing of the end effector (e.g., advancing a knife along the endeffector to fire staples and cut tissue, adjunct material, and anyrestraining elements), as will be described in greater detail below.

FIG. 6 illustrates one embodiment of an end effector 1100 includingupper and lower jaws 1102, 1104, respectively, that can pivot betweenopen and closed configurations. As shown in FIG. 6, a staple cartridge1106 can be configured to releasably couple to the lower jaw member1104, and can include staple cavities 1108 having staples disposedtherein. The upper jaw 1102 can be in the form of an anvil having staplepockets 1103 formed therein and configured to receive and form staplesfired from the cartridge 1106. Both the upper jaw 1102 and cartridge1106 can include knife slots 1124,1110, respectively, configured toallow a knife to advance therealong.

As shown in FIG. 6, an anvil assembly 1120 can be configured toreleasably couple to an inward tissue-facing surface 1107 of thecartridge 1106 and/or an inward-facing surface 1103 of the upper jaw1102. The anvil assembly 1120 can include an anvil plate 1128 having arectangular shape that can extend along either the upper jaw 1102 orcartridge 1106. The anvil plate 1128 can include an anvil adapter 1126along an outward-facing surface of the anvil plate 1128. The anviladapter 1126 can include plate features configured to mate with jawfeatures along the inward-facing surface 1103 of the upper jaw 1102(see, for example, FIG. 11) thereby assisting with securing thealignment between the anvil plate 1128 and the upper jaw 1102. The anvilplate 1128 can further include staple pockets 1130 (shown as imprintsalong an outward-facing surface of the anvil plate 1128) that arerecessed along an inward tissue-facing surface 1129 of the anvil plate1128. The staple pockets 1130 can be arranged along the anvil plate 1128such that each staple pocket 1130 corresponds to a staple cavity 1108 ofthe cartridge 1106 for assisting with forming the staples (e.g.,stapling tissue together and/or adjunct to tissue). The anvil plate 1128can include a knife channel 1132 that extends longitudinally along theanvil plate 1128 and that is configured to allow a knife to advancetherealong.

In some embodiments, the anvil plate 1128 can include one or morealignment features 1134 that can assist with maintaining alignmentbetween the anvil plate 1128 and the upper jaw 1102. For example, asshown in FIG. 6, the anvil plate 1128 can include proximal and distalalignment features 1134 that extend upward from the outward-facingsurface of the anvil plate 1128 toward the upper jaw 1102. The alignmentfeatures 1134 can be configured as tabs that mate with one or morerecesses, slots, through-holes, etc., in the upper jaw 1102. Dependingon the configuration of the upper jaw 1102, the alignment features 1134may slide longitudinally within the recesses, slots, through holes,etc., of the upper jaw 1102 as the jaw members move between the open andclosed positions thus maintaining alignment between the anvil plate 1128and the upper jaw 1102 during opening and closing of the jaws.Additionally, the alignment features 1134 can function to maintainalignment between the anvil plate 1128 and the cartridge 1106. Properalignment between the anvil plate 1128 and the cartridge 1106 ensuresthat staples contact staple pockets 1130, and form properly, when firedfrom the cartridge 1106.

As shown in FIG. 6, the anvil assembly 1120 can also include one or moreattachment features 1138 for coupling the anvil plate 1128 to thecartridge 1106, such as to the inward tissue-facing surface 1107 of thecartridge 1106. In some embodiments, as shown in FIG. 6, the attachmentfeatures 1138 can include at least one bracket. The bracket can extendbetween the anvil plate 1128 and cartridge 1106 and can allow the anvilplate 1128 to pivot (e.g., along with the upper jaw) between an open andclosed configuration relative to the cartridge 1106. In someembodiments, the attachment features 1138 can function as a hinge andbiasing element that biases the anvil plate 1128 to the openconfiguration thereby allowing the anvil plate 1128 to pivot and followthe upper jaw 1102 when the jaws open.

The attachment features 1138 of the anvil assembly 1120, and the inwardtissue-facing surface 1107 of the cartridge 1106, can include couplingfeatures 1140, 1112, respectively. The coupling features 1140, 1112 canbe in the form of through-holes that enable, for example, pins 1142,rivets, or similar features, to extend therethrough and connect thecoupling features 1140 of the anvil assembly 1120 to the couplingfeatures 1112 on the cartridge 1106. This configuration allows the anvilplate 1128 and cartridge 1106 to be releasably coupled together therebyallowing the end effector to provide various stapling configurations byswitching out either the cartridge 1106 or anvil plate 1128. As such,the replaceable cartridge 1106 and anvil assembly 1120 can provide anadvantage over end effectors that are, for example, limited to theconfiguration of the staple pockets in the anvil.

Furthermore, it can be desirable for an end effector to include featuresand/or components that facilitate releasable attachment of an adjunct tothe end effector. For example, an adjunct can be attached, includingpre-attached during manufacturing or prior to a surgical procedure, tothe end effector using a restraining element, such as a suture. In oneembodiment, the suture can be elongated and made out of, for example, athermoplastic such as polydioxanone (PDS), an elastic material, and/orany other biocompatible material suitable for securing the adjunct tothe end effector. In some embodiments, the restraining element can becontinuous or non-continuous with opposing ends of the restrainingelement anchored to a part of the anvil assembly and/or cartridge. Whenthe stapler is fired, staples can fire through the tissue and adjuncttoward the anvil to be formed. A knife can travel through knife channelsin the cartridge, anvil plate, and upper jaw thereby cutting therestraining element and releasing the adjunct from the end effector toallow the adjunct to remain at the surgical site.

FIG. 7 illustrates an anvil assembly 1220 releasably coupled to acartridge 1206 with a first adjunct material 1244 coupled to an inwardtissue-facing surface of an anvil plate 1228 of an anvil assembly 1220,and a second adjunct material 1246 coupled to an inward tissue-facingsurface of the cartridge 1206. The first and second adjuncts 1244, 1246can each be secured to the anvil assembly 1220 and cartridge 1206,respectively, using one or more restraining elements or sutures 1248.Each suture 1248 can extend around the first adjunct 1244 and anvilplate 1228 or around the second adjunct 1246 and cartridge 1206, therebysecuring the first or second adjuncts 1244, 1246 to the respective anvilplate 1228 or cartridge 1206.

As shown in FIG. 7, the cartridge 1206 and/or a cartridge pan 1214(coupled to the cartridge 1206) can include one or more cartridgenotches 1256, and the anvil plate 1228 of the anvil assembly 1220 caninclude one or more anvil notches 1266. For example, the notches 1256,1266 can be shaped as curved recesses and can be configured to allow apart of the suture 1248 to sit therein for maintaining a position of thesuture 1248 relative to either the anvil plate 1228 or cartridge 1206.The notches 1256, 1266 can thus assist with preventing the suture 1248from slipping and unsecuring a position of either the first or secondadjunct 1244, 1246 relative to the anvil plate or cartridge,respectively.

For example, the first adjunct 1244 can be secured to an inwardtissue-facing surface of the anvil plate 1228 by a pair of sutures 1248(e.g., one suture 1248 positioned adjacent at a distal end of the anvilplate 1228 and one suture 1248 positioned adjacent a proximal end of theanvil plate 1228) that wrap around the first adjunct 1244 and anvilplate 1228. As shown in FIG. 7, portions of the proximally and distallypositioned sutures 1248 can be positioned in anvil notches 1266 along aside of the anvil plate 1228. The notches 1266 can prevent the sutures1248 from shifting or slipping longitudinally along the anvil plate1228, thereby ensuring that the sutures 1248 secure the first adjunct tothe anvil plate 1228.

Similarly, the second adjunct 1246 can be secured to an inwardtissue-facing surface of the cartridge 1206 by a pair of sutures 1248(e.g., one suture 1248 positioned adjacent a distal end of the cartridge1206 and one suture 1248 positioned adjacent a proximal end of thecartridge 1206) that wrap around the second adjunct 1246 and cartridge1206. As shown in FIG. 7, portions of the proximally and distallypositioned sutures 1248 can be positioned in cartridge notches 1256along a side of the cartridge 1206 and/or cartridge pan 1214. Thecartridge notches 1256 can prevent the sutures 1248 from shifting orslipping longitudinally along the cartridge 1206 thereby ensuring thatthe sutures 1248 secure the second adjunct 1246 to the cartridge 1206.

As shown in FIG. 7, the first adjunct 1244 can include first adjunctnotches 1262 along opposing sides of the first adjunct 1244, and thesecond adjunct 1246 can include second adjunct notches 1263 alongopposing sides of the second adjunct 1246. The first and second adjuncts1244, 1246 can be made of the same material, or they can be made ofdifferent materials. The first adjunct notches 1262 can be positionedalong the first adjunct 1244 such that first adjunct notches 1262 alignwith the anvil notches 1266 when the first adjunct 1244 is properlyaligned with the anvil plate 1228 (e.g., the adjunct surface area of thefirst adjunct covers the inward tissue-facing surface of the anvil plate1228). As such, when the suture 1248 extends around the first adjunct1244 and anvil plate 1228 and along the first adjunct notches 1262 andanvil notches 1266, the suture 1248 secures a desired positioningbetween the first adjunct 1244 and the anvil plate 1228. Similarly, thesecond adjunct notches 1263 can be positioned along the second adjunct1246 such that the second adjunct notches 1263 align with the cartridgenotches 1256 when the second adjunct 1246 is properly aligned with thecartridge 1206 (e.g., the second adjunct surface area of the secondadjunct covers the inward tissue-facing surface of the cartridge 1206).As such, when the suture 1248 extends around the second adjunct 1246 andcartridge 1206 and along the second adjunct notches 1263 and cartridgenotches 1256, the suture 1248 secures a desired positioning between thesecond adjunct 1246 and the cartridge 1206. Each of the sutures 1248 canbe made of the same material, or one or more of the sutures 1248 can bemade of a different material.

Although the cartridge notches 1256, anvil notches 1266, and first andsecond adjunct notches 1262, 1263 are shown as U-shaped cutouts, any oneof the cartridge notches 1256, anvil notches 1266, and first and secondadjunct notches 1262, 1263 can have any number of shapes and/or sizesthat allow a part of suture to extend therealong for securing the suturein position relative to either the anvil plate 1228 or cartridge 1206.For example, any one of the cartridge notches 1256, anvil notches 1266,and first and second adjunct notches 1262, 1263 can be V-shaped,squared, or any other geometry. Furthermore, any number of notches(e.g., cartridge notches 1256, anvil notches 1266, and first and secondadjunct notches 1262, 1263) and lengths of suture 1248 can be used tosecure the position of either the first or second adjuncts 1244, 1246.Alternatively, rather than notches 1256, 1266, the cartridge 1206,cartridge pan 1214, and/or the anvil plate 1228, can include holesthrough which sutures 1248 can be threaded. Similarly, the adjuncts1244, 1246 can include holes that align with holes on the cartridge1206, cartridge pan 1214, and/or anvil plate 1228. Sutures can bethreaded through the holes in the adjuncts 1244, 1246 and through theholes in the cartridge 1206, cartridge pan 1214, and/or the anvil plate1228, to retain the adjuncts 1244, 1246 on inward tissue-facing surfacesof the cartridge 1206 and the anvil plate 1228.

In some embodiments, it can be desirable to angle a suture extendingaround the adjunct material and cartridge to ensure that the adjunct isdetached from the cartridge after at least one staple has been deployed(e.g., thereby securing the adjunct to the tissue).

FIG. 8 illustrates upper and lower jaws 1302, 1304 in a closedconfiguration, clamped around tissue 1346, with an adjunct 1344 securedto an inward tissue-facing surface of a cartridge 1306 that is seatedwithin the lower jaw 1304. As shown in FIG. 8, the adjunct 1344 issecured to the cartridge 1306 using a suture 1348 that extends aroundthe adjunct 1344 and cartridge 1306 at an angle (1 a). For example, thesuture 1348 can extend along the adjunct 1344 at a location proximal tothe location at which the suture 1348 extends around the back side ofthe cartridge 1306. As such, as shown in FIG. 8, a side view of thesuture 1348 extending around the adjunct 1344 and cartridge 1306 showsthe suture 1348 extending at an angle (1 a) across the side of thecartridge 1306. As illustrated in FIG. 8, a knife 1338 can be configuredto advance along the cartridge 1306 to cut the tissue 1346, suture,1348, and adjunct 1344, using a knife blade 1336. The knife 1338 canalso be configured to drive staples 1347 from the cartridge 1306 as itadvances along the cartridge 1306. As the knife advances along thelength of the cartridge 1306, it can push a wedge sled 1340, which canpush staple drivers 1342 that hold staples 1347 in a tissue-facingdirection to form the staples 1347. The angling of the suture 1348 canensure that the suture 1348 is in a position to be cut without beingstapled to the tissue 1346. The angled suture 1348 can be positionedsuch that the knife blade 1336 is the first part of the knife 1338 thatcontacts the suture 348 in order to cause the angled suture 1348 to becut approximately upon contact with the knife 1338.

Alternatively or in addition to using continuous restraining elements,such as continuous sutures or lengths of suture that couple end to end,one or more non-continuous restraining elements that anchor opposingends of the restraining elements to components of the cartridge and/oranvil assembly can be used.

FIGS. 9A-9C illustrate another embodiment of an anvil assembly 1420releasably coupled to a cartridge 1406 with a cartridge pan 1414 coupledto a bottom side of the cartridge 1406. As shown in FIGS. 9A-9C, a firstadjunct material 1444 can be coupled to an inward tissue-facing surfaceof the anvil plate 1428 of the anvil assembly 1420 and a second adjunctmaterial 1446 can be coupled to an inward-tissue facing surface of thecartridge 1406. The first and second adjuncts 1444 and 1446 can besecured to the anvil assembly 1420 and cartridge 1406 with one or moresutures 1448. Furthermore, the anvil assembly 1420 and/or cartridge 1406can include one or more suture attachment sites 1456 that are configuredto couple a part (e.g., opposing ends) of the suture 1448 thereto. Asshown in FIGS. 9B and 9C, at least one pair of attachments sites 1456can be positioned along an outward-facing surface of the anvil plate1428 of the anvil assembly 1420 (as shown in FIGS. 9A and 9B), andanother pair of attachment sites 1456 can be positioned along anoutward-facing surface of the cartridge 1406 and/or an outward-facingsurface of the cartridge pan 1414 (as shown in FIG. 9C).

The suture 1448, and more particularly each of the opposing ends of thesuture 1448, can be heat staked, welded, or otherwise adhered to theattachment sites 1456. In some implementations, the attachment site 1456can include a texture that assists with securing the suture 1448 to theattachment site. For example, the attachment site 1456 can be roughenedor otherwise made to include a textured surface. The cartridge 1406and/or anvil assembly 1420 can include one or more attachment site 1456,and each attachment site 1456 can include any of a variety of sized andshaped surface areas. For example, the attachment sites 1456 can havevarious shapes, such as circular, triangular, or any other shapedsurface area. Additionally, some attachment sites 1456 can be coatedwith a material that improves the attachment of the suture 1448.Alternatively or in addition, small posts, barbs or hooks can be used atthe attachment sites 1456 to secure the suture 1448 in place. Althoughtwo sutures 1448 and two pairs of attachment sites 1456 are used tosecure each adjunct 1444, 1446 in FIGS. 9A-9C, any number of sutures andattachment sites can be used to secure the adjuncts to the anvil plateand/or cartridge.

FIGS. 10A-10B illustrate another embodiment of a suture 1548 extendingacross a second adjunct 1546 for securing the second adjunct 1546 to acartridge 1506. As shown in FIG. 10A, opposed ends of the suture can besecured to attachment sites 1556 positioned along opposed sides of thecartridge 1506. More than one suture 1548 can be secured across thesecond adjunct and secured to attachment sites 1556 positioned onopposed sides of the cartridge 1506 or lower jaw 1514. Similarly,opposed ends of suture can be secured to attachment sites positionedalong opposed sides of the anvil plate or other part of the anvilassembly.

Additionally or alternatively, as shown in FIG. 10B, a pan 1516 can bereleasably coupled to the cartridge 1506 such that an inner surface ofthe pan 1516 can provide a compressive force against the ends of thesuture 1548, thereby further securing the coupling between the ends ofthe suture 1548 and the attachment sites 1556. The pan 1516 can alsoprotect the ends of the suture 1548 from being dislodged from thecartridge 1506 as the cartridge 1506 is inserted into a channel of alower jaw of an end effector. Various other components can be coupled toeither the cartridge and/or anvil plate for providing additionalsecuring forces at the point of attachment between the suture andattachment sites, which are within the scope of the is disclosure.

FIG. 11 illustrates anvil features 1670 that can extend from anoutward-facing surface 1671 of the anvil plate 1628 and that areconfigured to mate with jaw features 1672 (e.g., cavities) that extendinto an inward-facing surface 1673 of the upper jaw 1602. The anvilfeatures 1670 can have a similar shape as the jaw features 1672 suchthat, when mated, the outward-facing surface of the anvil plate 1628 canbe restricted from sliding against the inward-facing surface of theupper jaw 1602, thereby assisting with maintaining a preferred alignmentbetween the anvil plate 1628 and the upper jaw 1602. The anvil features1670 and/or jaw features 1672 can include stamped metal and/or elastomerand can have any number of a variety of shapes and sizes. Furthermore,it is within the scope of this disclosure for the cartridge and/or lowerjaw to include features that mate with corresponding features along thelower jaw for assisting with maintaining a desired position of thecartridge relative to the lower jaw.

Surgical End Effector Adjunct Attachment

Various exemplary devices, systems and methods are provided forreleasably retaining a frame with an adjunct to a jaw of an end effectorof a surgical instrument. In certain exemplary embodiments, the framecan include retaining features for coupling an adjunct to atissue-facing surface of the frame, thereby releasably coupling theadjunct material to the jaw of the end effector. In someimplementations, the frame can include a plurality of retaining featuresthat are configured to engage the adjunct material thereby creating atension in the adjunct material, which can further assist with securingthe frame to the jaw. The frame can also include various attachmentfeatures (e.g., attachment arms) that are configured to assist withreleasably coupling the frame to the jaw.

In other embodiments, a removable applicator can be member provided forretaining at least one adjunct material and for aligning and couplingthe adjunct material to a frame that is already secured to the jaw.Thus, in some implementations the jaws can be manipulated to engage theadjunct material retained by the applicator member, thereby mounting theadjunct onto the end effector. In particular, a force applied to theapplicator member can cause the applicator member to release the atleast one adjunct material and to transfer the at least one adjunctmaterial to at least one respective frame secured to a jaw of the endeffector.

FIGS. 12A and 12B illustrate one exemplary embodiment of a frame 2100that is configured to releasably couple to an upper jaw 2102 of an endeffector and to releasably retain an adjunct material (not shown) on atissue-facing surface 2105 of the frame 2100. As shown, the frame 2100can be in the form of an elongated body 2106 having an outward facingsurface 2108 that can mate to and extend along an anvil surface 2103 ofan anvil of the upper jaw 2102. One or more pairs of attachment arms2110 can extend from the elongated body 2106, with each pair ofattachment arms 2110 extending from opposing sides of the elongated body2106 and arching towards a longitudinal axis of the elongated body 2106.The attachment arms 2110 can have a shape that is similar to an outerprofile of the outward facing surface of the upper jaw 2102, therebyallowing the attachment arms to extend around a part of the outwardfacing surface of the upper jaw 2102 for securing the frame 2110 to theupper jaw 2102. Although the frame 2110 is shown and described as beingconfigured for releasably securing to the upper jaw 2102, the frame 2100can be configured for releasably securing to the upper jaw and/or lowerjaw without departing from the scope of this disclosure.

Some embodiments of the attachment arms 2110 can be made out of acompliant and or elastic material that allows the attachment arms 2110to deform or spread apart. The compliant and/or elastic attachment arms2110 can assist with coupling the frame 2100 to the upper jaw 2102, aswell as provide a compressive force against the outward facing surfaceof the upper jaw 2102 thereby securing the attachment and position ofthe frame 2100 to the upper jaw 2102. For example, the frame 2100 can becoupled to the upper jaw 2102 by guiding a distal end of the upper jaw2102 through a space created by the attachment arms 2110 and/orspreading the attachment arms 2110 to allow the upper jaw 2102 to bepositioned within the arcs of the attachment arms 2110.

The frame 2100 can be made out of one or more of a variety of materials,including compliant and/or elastic materials. For example, the frame canbe made out of any number of materials (e.g., surgical grade), such asmetals and polymers, without departing the scope of this disclosure.

In some embodiments, the upper jaw 2102 and/or frame 2100 can include alocking mechanism that assists with releasably securing the frame 2100to the upper jaw 2102. For example, the upper jaw 2102 can include alocking feature at a proximal end that interacts and locks the frame2100 to the upper jaw 2102 when the frame 2100 is loaded onto the upperjaw 2102. Furthermore, the upper jaw 2102 and/or frame 2100 can includea release feature (e.g., shown as a tab 2107 in FIG. 12B) that isconfigured to force or allow the release of the frame 2100 from theupper jaw 2102 when acted upon (e.g., pushed or pivoted).

As discussed above, the tissue facing surface 2105 of the frame 2100 canbe configured to releasably secure an adjunct material thereto forallowing the adjunct material to be stapled to tissue and to remain at asurgical site. The frame 2100 can be configured such that the adjunctmaterial can be secured to the frame 2100, however, the adjunct materialcan also be uncoupled from the frame 2100 thereby allowing the adjunctmaterial, and not the frame 2100, to remain at the surgical site.Various attachment techniques can be utilized to mate an adjunct to theframe, such as an adhesive, fasteners, or any other chemical ormechanical attachment techniques.

FIGS. 13A-13E illustrate another embodiment of a frame 2200 that can bereleasably coupled to a jaw of an end effector, such as an upper jaw2202. The frame 2200 can be configured to releasably retain an adjunctmaterial 2220 to thereby releasably secure the adjunct material 2220 tothe upper jaw 2202. Similar to the embodiment above, the frame 2200 canbe coupled to either the upper and/or lower jaw without departing fromthe scope of this disclosure. As shown in FIGS. 13B-13E, the frame 2200can include attachment arms 2210 that extend from an elongated body 2206of the frame 2200 and that can be shaped to conform to an outward facingsurface of the upper jaw 2202. As such, the attachment arms 2210 canassist with securing the position of the frame 2200 and adjunct 2220relative to the upper jaw 2202, such as before and during firing ofstaples.

As shown, the tissue facing surface 2205 of the frame 2200 can include aplurality of retaining features 2222 positioned along the length of theelongated body 2206. The plurality of retaining features 2222 can beconfigured to releasably secure the adjunct material 2220 to the frame2200 such that the adjunct material 2220 can remain securely coupled tothe frame 2200 at least until firing of a knife along the end effectorthereby cutting the adjunct material 2220. The retaining features 2222can be shaped and engaged with the adjunct material 2220 such that theyallow the adjunct material 2220 to release attachment from the frame2200 after the adjunct material 2220 has been cut and as the endeffector moves away from the surgical site after firing of the staples.The frame 2200 can remain coupled to the end effector, such as the upperjaw, as the adjunct is released. A user can subsequently decouple theframe 2200 from the jaw or load another adjunct material 2220 onto theframe 2200. As such, the frame 2200 is configured such that the adjunctmaterial 2220 is allowed to remain at the surgical site and the frame2200 remains attached to the end effector so that the frame 2200 is notleft at the surgical site and can either be reused or disposed of.

As shown in FIG. 13A, the frame 2200 can include at least one slot oropening 2226 that extends along a length of the elongate body 2206. Eachopening 2226 can be configured to allow staples to pass therethrough andinto the adjunct and tissue engaged between the jaws, thereby staplingthe adjunct material 2220 to adjacent tissue. The openings 2226 can beshaped such that they surround the staple cavities of the cartridgeand/or staple forming cavities of the anvil surface thereby allowing thefiring of the staples without the frame 2200 interfering or gettingstapled to tissue.

The frame 2200 can also include a hinge 2230 along a length of theelongate body 2206 that allows the elongate body 2206 to apply tensionto the adjunct. As shown in FIG. 13A, the hinge 2230 can extend along alongitudinal axis of the elongated body 2206 and can include a V-shapedprofile. The V-shaped hinge 2230 can be configured to extend a distancewithin a knife slot 2211 of the upper jaw 2202 when the frame is coupledto the upper jaw, as shown in FIGS. 13C-13D. This can allow a knife toadvance along the knife slot 2211 and cut the adjunct material 2220without interference from the frame 2200. In an exemplary embodiment,however, the hinge 2230 can be formed from a material that can be cut bythe knife as it is advanced through the knife slot 2211. Cutting of thehinge 2230 can assist with releasing the adjunct from the frame 2200, aswill be discussed in more detail below.

FIGS. 13C-13D illustrate the frame 2200 coupled to the upper jaw, withthe hinge 2230 extending into the knife slot 2211. The adjunct material2220 is also shown coupled to a plurality of retaining features 2222.The retaining features 2222 can be made out of a rigid, semi-rigid, orflexible material and can include a hook or securing feature 2223 thatextends outward away from the longitudinal axis of the elongate body2206. This configuration of the retaining features 2222 can allow afirst side of the adjunct material 2220 to be secured to a plurality ofretaining features 2222 positioned on a first side of the hinge 2230.The adjunct material 2220 can then be pulled so that it is under tensionbefore securing a second side of the adjunct material 2220 to theretaining features 2222 positioned on a second side of the hinge 2230,as shown in FIG. 13C. The retaining features 2222 on the first side ofthe hinge 2230 can thus pull in an opposite direction from the retainingfeatures 2222 on the second side of the hinge 2230 thereby placing theadjunct material under tension. The retaining features 2222 can alsodeform or bend when the adjunct material 2220 is under tension therebyfurther securing the adjunct material 2220 to the frame 2200.Furthermore, having the retaining features engage the adjunct material2220 under tension can pull opposing sides of the elongate body 2206closer together thereby allowing the hinge 2230 to form a first angle2232 a and further securing the frame 2200 to the upper jaw 2202.

As mentioned above, a knife can be advanced along the knife slot 2211thereby cutting the adjunct material 2220 as well as cutting at leastpart of the hinge 2230. By cutting the adjunct material 2220 positionedadjacent the knife slot 2211, the tension in the adjunct material 2220caused by the retaining features 2222 pulling on the adjunct materialfrom opposing sides of the knife slot 2211 can be released. When thistension along the adjunct material 2220 is released, the retainingfeatures 2222 can reform (e.g., straighten) thereby allowing the adjunctmaterial 2220 to be pulled off of the frame, such as after beingstapled. The opposing sides of the elongate body to 2205 can also movefurther apart when the tension along the adjunct material 2220 isreleased, which can allow the hinge 2230 to form a second angle 2232 b(see FIG. 13D). The second angle 2232 b can be larger than the firstangle 2232 a thereby allowing the opposing sides of the elongate body2206 to move further apart from each other, such as for allowing a userto decouple the frame 2200 from the upper jaw 2202. Similarly, if a partof the hinge 2230 is cut, the opposing sides of the elongate body 2206can move further apart to allow a user to decouple the frame from theupper jaw 2202. In some embodiments, the frame can include an adhesiveand/or one or more features that can couple to a part of the knife slotto further assist in securing the frame to the upper jaw 2202.

FIG. 13E illustrates the outward facing surface 2221 of the upper jaw2202 having attachment arm coupling features 2240 therealong that areconfigured to prevent attachment arms 2210 of the frame 2200 from movingrelative to a length of the upper jaw 2202, such as when the frame 2200is coupled to the upper jaw 2202. As shown, each attachment arm couplingfeature 2240 can include a recess that has a shape and depth that allowsan attachment arm 2210 to be seated therein to prevent the attachmentarm 2210 from sliding out of the attachment arm coupling features 2240and/or along the length of the upper jaw 2202. For example, theattachment arm coupling feature 2240 can be in the form of a recessedband that extends at an arc perpendicular to the longitudinal axis ofthe upper jaw.

Because the attachment arm coupling features 2240 can prevent the frame2200 from sliding along the upper jaw 2202 even during loading of theframe 2200 onto the upper jaw 2202, the frame 2200 can be snapped on bydeforming (e.g., elastically) the attachment arms 2210 to allow theupper jaw 2202 to fit within the confines of the attachment arms 2210.The attachment arms can be aligned with the attachment arm couplingfeatures 2240 such that each of the attachment arms 2210 can springtowards the outward facing surface and into a corresponding attachmentarm coupling feature 2240. Once coupled, the attachment arms 2210 andattachment arm coupling features 2240 can prevent the frame 2200 fromsliding along the upper jaw 2202 thereby ensuring a desired positioningof the adjunct material 2220 relative to the upper jaw 2202.

As mentioned above, the frames 22100, 2200 can be configured to mate toeither the upper and/or lower jaws. In addition, a frame can be coupledor mounted to a jaw of an end effector prior to having an adjunctcoupled to the frame. As such, a user may need to align and mount anadjunct material to the frame when the frame is coupled to the jaw. Someframes can be reusable such that more than one adjunct can be used witha single frame. FIGS. 14A-14B illustrate a reusable frame that can becoupled to either the upper or lower jaw of the end effector and, asshown in FIG. 14C, an applicator member can be used to position andassist with mounting at least one adjunct material onto a respectiveframe coupled to either the upper or lower jaw.

FIG. 14A illustrates an embodiment of a frame 2300 including an overlay2350 that is configured to extend along a part of an upper jaw 2302. Insome embodiments, the overlay 2350 can include a flexible elongatedtubular member that can slide over the upper jaw 2302 thereby coveringan anvil surface 2303 of the upper jaw 2302. In some embodiments, theoverlay 2350 can include an elongated surface that can cover the anvilsurface 2303 and can further include edges that wrap around one or moresides of the upper jaw to thereby secure the overlay to the upper jaw.The overlay 2350 can further include an adhesive material that canassist with securing the position of the overlay 2350 relative to theupper jaw 2302. A tissue facing surface 2305 of the overlay 2350 caninclude at least one row of retaining features 2322 that are configuredto assist with coupling an adjunct material 2320 thereto. For example,the tissue facing surface 2305 of the overlay 2350 can include two rowsof retaining features 2322 with each row positioned along opposing sidesof the anvil surface 2303 when the overlay 2350 is coupled to the upperjaw 2302.

FIG. 14B illustrates the upper and lower jaws 2302, 2304 each having anoverlay 2350 a, 2350 b covering an outer surface thereof. As shown inFIG. 14B, an adjunct material 2320 can be releasably mated to both ofthe upper and lower jaws 2302, 2304. The adjunct material 2320 caninclude at least one row of complimentary retaining features 2325 thatare configured to engage and releasably secure to at least one row ofretaining features 2322 along the overlay 2350. For example, the adjunctmaterial 2320 can include two rows of complimentary retaining features2325, with each row positioned along opposing sides of the adjunctmaterial 2320 such that they align with the two rows of retainingfeatures 2322 along the overlay 2350, as shown in FIG. 14B. As such, theadjunct material 2320 can be coupled to an overlay 2350 by aligning therows of retaining features 2322 along the overlay 2350 with the rows ofcomplimentary retaining features 2325 along the adjunct material 2320.Once aligned, the retaining features 2322 and complimentary retainingfeatures 2325 can be engaged thereby releasably securing the adjunctmaterial 2320 to the overlay 2350. The engagement between the retainingfeatures 2322 and complimentary retaining features 2325 can be strongenough to maintain the position of the adjunct material 2320 relative tothe overlay 2350 prior to firing of staples, while allowing the adjunctmaterial 2320 to uncouple and remain stapled at the surgical site afterfiring of the staples. The retaining features 2322 and/or complimentaryretaining features 2325 can have various configurations, such as hookand loop members, various self-adhering materials, snap-fit features,etc. Furthermore, although the retaining features 2322 and complimentaryretaining features 2325 are shown and described as being formed intorows along the overlay and adjunct material 2320, respectively, theretaining features 2322 and complimentary retaining features 2325 canhave any number of shapes and configurations. For example, positioningretaining features 2322 and complimentary retaining features 2325 alongopposing sides of the anvil surface 2203 (when the overlay 2350 iscoupled to the upper jaw) allows the retaining features 2322 andcomplimentary retaining features 2325 to not interfere with either theadvancing of the knife and/or firing of staples, however, otherconfigurations can also achieve this.

One or both of the adjunct materials 2320 can be releasably retained onthe overlays 2350 a, 2350 b coupled to the upper and lower jaws 2302,2304, respectively, using an applicator member 2360 shown in FIG. 14C.The applicator member 2360 can be in the form of a frame-like holderconfigured to releasably retain one or both of the adjunct materials2320 a, 2320 b. In the illustrated example, the applicator member 2360is in the form of first (e.g., bottom) and second (e.g., top) generallyrectangular housings 2324, 2326 coupled to one another as shown in FIG.14C. As also shown in FIG. 14C, the first and second housing 2324, 2326can engage edges of the long sides of the adjunct materials 2320 a, 2320b therebetween. In other words, the applicator member 2360 can be in theshape of a generally U-shaped frame that surrounds an outer perimeter ofat least two sides (e.g., long sides) of one or two adjunct materials.In particular, as shown in FIG. 14C, the applicator member 2360 canexpose the complimentary retaining features 2325 thereby allowing thecomplimentary retaining features 2325 to align with and couple to theretaining features 2322 along the overlay 2350. It should be appreciatedthat the adjunct materials 2320 a, 2320 b and the first and secondhousings 2324, 2326 of the applicator member 2360 encompassing them canbe symmetrical. Thus, either of the adjunct materials 2320 a, 2320 b canbe applied to either overlay 2350 a, 2350 b coupled to the upper orlower jaw 2302, 2304, respectively.

The applicator member 2360 can be formed from any suitable material(e.g., plastic), and its walls can be relatively thin and it can bedisposable. In use, to transfer the adjunct materials 2320 a, 2320 b tothe overlays 2350 a, 2350 b, respectively, the upper or lower jaws 2302,2304 can be clamped together into the opening in the applicator member2360, with the complimenting retaining features 2325 of the adjunctmaterials 2320 a, 2320 b aligned with the retaining features 2322 alongthe overlays 2350 a, 2350 b. In this way, force applied by the jaws2302, 2304 can cause the adjunct materials 2320 a, 2320 b to separatefrom the applicator member 2360 and to be engaged with the overlays 2350a, 2350 b. In particular, in this example, as force is applied to theapplicator member 2360 by the jaws 2302, 2304 of the end effector, thecomplimentary retaining features 2325 of the adjunct materials 2320 a,2320 b are securely coupled to the retaining features 2322 along theoverlays 2350 a, 2350 b.

After the adjunct materials 2320 a, 2320 b are transferred to theoverlays positioned over the upper and lower jaws 2302, 2304, the jawscan be opened and the applicator member 2360 can be separated from theend effector. The overlays 2350 a, 2350 b attached to the upper andlower jaws 2302, 2304 can thus be mated with their respective adjunctmaterials 2320 a, 2320 b, as shown in FIG. 14B, and can then be used asdesired in a surgical procedure.

It should be appreciated that the applicator member 2360 is shown toreleasably retain two adjunct materials 2320 a, 2320 b by way of exampleonly, and the applicator member 2360 or a similar component configuredto releasably hold at least one adjunct material 2320 can be used totransfer an adjunct material 2320 only to a single frame or overlaycoupled to the end effector. Moreover, the applicator member can be usedto attach one or more adjuncts to any of the frames and/or jawsdisclosed herein.

Surgical Adjunct Retaining Mechanism

An adjunct can be releasably retained on an end effector of a surgicaltool, such as a surgical stapler, using a plurality of retainingelements. The retaining elements can be configured to retain the adjunctto the end effector with a mechanical force until a force is applied tothe adjunct that overcomes the mechanical force, thereby allowingrelease of the adjunct from the end effector and into a patient's bodywhere it may provide any number of benefits, as discussed above. Theforce can be applied to the adjunct in the normal course of use of thesurgical tool, such as in the course of deploying staples from the endeffector, which may facilitate ease of use since a user need not takeany special action to release the adjunct. The retaining elements can beconfigured to releasably retain the adjunct to the end effector withoutusing an adhesive, which may make the system easier to assemble, mayfacilitate release of the adjunct from the end effector since adhesivemay require application of a higher force to release an adjunct, and/ormay prevent staple cavities or other components of a surgical tool frombeing clogged by or otherwise compromised in function by the adhesive.The retaining elements can be on a retainer releasably coupled to theend effector. Existing end effectors may be retrofitted with a retainerand/or existing staple cartridges may be coupled to the retainer.Existing end effectors that include a metal pan may have the panmodified to include the features of a retainer as described herein.

FIG. 15 illustrates one embodiment of a staple cartridge 3100 coupled toa retainer 3102 including a plurality of retaining elements 3104configured to releasably retain an adjunct 3106 to the staple cartridge3100. The staple cartridge 3100 is generally configured and used similarto the staple cartridge 40 of FIGS. 1 and 2, e.g., has a plurality ofstaple cavities 3108 in a tissue-facing surface 3110 thereof that eachseat a staple therein (the staples are obscured in FIG. 15), isconfigured to have a sled moved therethrough to push the staples out ofthe staple cavities 3108, has a longitudinal slot 3112 through which aknife or other cutting element can translate to cut tissue, etc. Thestaple cartridge 3100 is releasably seated in a lower jaw 3114 of an endeffector of a surgical tool. The cartridge 3100 is seated in theretainer 3102, which is seated in a channel in the lower jaw 3114. Thesled that translates along the cartridge 3100 can thus translate alongan inner bottom surface of the retainer 3102. The lower jaw 3114includes a coupling mechanism 3116 that couples the lower jaw 3114 to anupper jaw of the end effector that is configured to cooperate with thelower jaw 3114 to engage and staple tissue, as discussed above.

The retainer 3102 in this illustrated embodiment is in the form of a panor tray that has a bottom with opposed sidewalls extending upwardlytherefrom. The cartridge 3100 is fixedly seated in the retainer 3102 inthis illustrated embodiment, e.g., is not removable from the retainer3102. The cartridge 3100 and the retainer 3102 are thus configured to beremovably and replaceably seated in the lower jaw 3114 as a unit. Thecartridge 3100 being fixed to the retainer 3102 may help ensure that theretaining elements 3104 are in a desirable location relative to thecartridge 3100, which may help the adjunct 3102 be desirably positionedover the cartridge's tissue-facing surface 3110 and/or may help ensurealignment of the retaining elements 3104 with cut-outs or pockets 3118formed in the cartridge 3100, which are also shown in FIG. 16 and arediscussed further below. In other embodiments, a cartridge can bereleasably retained in a retainer, which may allow for re-use of theretainer with different staple cartridges. The retainer in suchembodiments is configured to be seated in an end effector's lower jaweither before or after the cartridge is seated in the retainer.

The retainer 3102 can be formed from any of a variety of materials. Inan exemplary embodiment, the retainer 3102 is formed from a metal, suchas stainless steel, titanium, or a shape memory metal such as Nitinol.

The retaining elements 3104 are longitudinally aligned and arepositioned along opposed longitudinal sides 3102 a, 3102 b of theretainer 3102. The retaining elements 3104 are thus positioned alongopposed longitudinal sides 3100 a, 3100 b of the cartridge 3100. In anexemplary embodiments, a first number of the retaining elements 3104 areon one side 3102 a (e.g., left side) of the retainer 3102 and a secondnumber of the retaining elements 3104 are on the other side 3102 b(e.g., right side) of the retainer 3102. The first and second numbers ofthe retaining elements 3104 can be equal, as in this illustratedembodiment in which there are eleven retaining element 3104 on each side3102 a, 3102 b of the retainer 3102 for a total or twenty-two retainingelements 3104. Having an equal number of retaining elements 3104 onopposed sides 3102 a, 3102 b of the retainer 3102 may help provide evensecuring of the adjunct 3106 to the cartridge 3100. However, the firstand second numbers of the retaining elements 3104 can vary. In anexemplary embodiment there are at least three retaining elements 3104 oneach side 3102 a, 3102 b of the retainer 3102. For example, oneretaining element 3104 can be near a proximal end thereof for releasableattachment to the adjunct 3100 near a proximal end thereof, oneretaining element 3104 can be near a distal end thereof for releasableattachment to the adjunct 3100 near a distal end thereof, and oneretaining element 3104 can be near a middle thereof for releasableattachment to the adjunct 3100 near a middle thereof. Any additionalretaining elements 3104 can be located between the proximal retainingelement and the middle retaining element and/or between the distalretaining element and the middle retaining element. Regardless of anumber of retaining elements 3104 on each side 3102 a, 3102 b of theretainer 3102, the retaining elements 3104 can be equidistantly spacedtherealong, as in this illustrated embodiment, which may help evenlysecure the adjunct 3106 to the cartridge 3100.

The retaining elements 3104 extend upwardly from the retainer 3102,e.g., in a direction toward the upper jaw (e.g., the anvil) coupled tothe lower jaw 3114. The retaining elements 3104 thus extend in adirection 3D1 substantially perpendicular to a longitudinal axis 3100Aof the cartridge 3100 and a longitudinal axis 3114A of the lower jaw3114. The retaining elements 3104 extending upwardly may help preventlateral movement of the adjunct 3106 engaged therewith relative to thecartridge 3100, which may help ensure that all of the staples in thecartridge 3100 are deployed through the adjunct 3106, e.g., that each ofthe staples pierces the adjunct 3106, which may facilitate release theadjunct 3106 from the retaining elements 3104 and the cartridge 3100.The retaining elements 3104 each extend a distance above thetissue-facing surface 3110 of the cartridge 3100, which allows theadjunct 3106 engaged by the retaining elements 3104 to be seated on andbe substantially flat on the tissue-facing surface 3110 of the cartridge3100. A person skilled in the art will appreciate that although theadjunct 3106 may not be precisely flat it can nevertheless be consideredto be substantially flat due to any number of factors, such asflexibility of the adjunct material and/or manufacturing tolerance atthe adjunct's surface.

Each of the retaining elements 3104 in this illustrated embodiment is inthe form of a hook. Each of the hooks is angled or oriented in a sameproximal direction. The hooks are thus angled or oriented in a directionthat is opposite to the distal direction that the sled translates alongthe cartridge 3100 and lower jaw 3114. As the sled translates distallyalong the cartridge 3100 and lower jaw 3114 to eject the staples, theupward movement of the staples out of the staple cavities 3108 exerts aforce, e.g., an upward force in a direction of the upper jaw againstwhich the staples are pushed, on the adjunct 3106. The adjunct 3106 isthus urged upwardly away from the cartridge 3100, which causes theadjunct 3106 to be released from the retaining elements 3104 by beingpushed thereoff. The retaining elements 3104 can experience deformationduring the release of the adjunct 3106 therefrom in response to theupward force. In other words, the pushing of the adjunct 3106 off theretaining elements 3104 may cause the hooks to bend upwardly. The forceexerted by the staples being ejected through the adjunct 3106 can thusbe enough to overcome the mechanical force that the retaining elements3104 exert to hold the adjunct 3106 thereto. In other embodiments,retaining elements in the form of hooks can each be angled or orientedin a same distal direction so as to be angled in the same direction thatthe sled translates along the cartridge and lower jaw. In this way, thesled's distal movement can help urge disengagement of the adjunct fromthe retaining elements as the sled travels in a distal direction todrive staples from the cartridge. The hooks in such an embodiment wouldbe less likely to experience plastic deformation than hooks orientedproximally and may not deform at all.

The retaining elements 3104 on the retainer 3102 can be integrallyformed with the retainer 3102, as in this illustrated embodiment, suchas with a stamping process. The retaining elements 3104 can thus also,in an exemplary embodiment, be formed from a metal. The retainingelements 3104 can be very thin, as in this illustrated embodiment, inwhich case the retaining elements 3104 will have some degree offlexibility even if formed from a rigid material such as metal. Thisflexibility can result in plastic deformation of the retaining elements3104 during release of the adjunct 3106 therefrom, e.g., one or more ofthe retaining elements 3104 may be irreversibly bent during release ofthe adjunct 3106, such as by being bent upwardly during stapledeployment as discussed above. In other embodiments, instead of beingintegral with the retainer 3102, the retaining elements 3104 can beseparate members attached thereto, such as by welding, adhesive, pressfit, etc.

In at least some embodiments, one or more of the retaining elements 3104can include a gripping feature thereon configured to facilitate grippingof the adjunct 3106. The gripping feature may help prevent prematurerelease of the adjunct 3106 from the cartridge 3100. For example, thegripping feature can be a textured surface on the retaining element 3104that increases friction between the retaining element 3104 and theadjunct 3106. For another example, the gripping feature can be anenlarged tip of the retaining element 3104, such as a bulb or ball atthe retaining element's tip, which may help prevent the adjunct 3106from prematurely sliding off the retaining element 3104 since passingover the enlarged tip will be made more difficult, e.g., require ahigher force to be released therefrom.

The cartridge 3100 has a plurality of cut-outs or pockets 3118 formedtherein. The cut-outs 3118 are longitudinally aligned and are positionedalong the opposed longitudinal sides 3100 a, 3100 b of the cartridge3100. The cut-outs 3118 are aligned with the retaining elements 3114such that each of the cut-outs 3118 has an associated retaining element3114. The cut-outs 3118 are each configured to seat a portion of theadjunct 3106 therein, as shown in FIG. 15, when the retaining elements3104 are holding the adjunct 3106 on the cartridge 3100. The cut-outs3118 may thus help prevent buckling of the adjunct 3106, which may allowthe staples to more evenly advance through the adjunct 3106. Thecut-outs 3118 each have a square shape in this illustrated embodimentbut can have other shapes, e.g., rectangular, semi-circular, etc.

The adjunct 3106 in this illustrated embodiment is a fibrous structurethat includes a plurality of fibers. As shown in FIGS. 15 and 17, theretaining elements 3104 can extend through the adjunct 3106 so as tohook the adjunct 3106 thereto. The fibers can separate to allow theretaining elements 3104 to extend therethrough at points 3105 where theadjunct 3106 engages the retaining elements 3104, although depending onvarious factors such as the tightness of the fiber's lattice structure,whether the retaining element's tips are blunted or pointed (the tipsare blunted in this illustrated embodiment), and the strength of theretaining elements 3104, the retaining elements 3104 can pierce throughthe fibrous structure so as to form holes therein at any one or more ofthe points 3105. The retaining elements 3104 pierce through the adjunct3106 in this illustrated embodiment. The adjunct 3106 may havepre-formed holes therein at locations where the retaining elements 3104will extend through the adjunct 3106, which may help the retainingelements 3104 all pass through the adjunct 3106 both during loading ofthe adjunct 3106 onto the retaining elements 3104 and during release ofthe adjunct 3106 from the retaining elements 3104.

In some embodiments, the adjunct 3106 can be releasably coupled to theretaining elements 3104 in manufacturing such that the cartridge 3100,retainer 3102, and adjunct 3106 can be provided to a user as anassembled unit. Providing such an assembled unit may save user timesince the assembly is pre-performed and/or may help ensure that theadjunct 3106 is properly secured to the cartridge 3100 and retainer3102. In other embodiments, the adjunct 3106 can be provided to a useras a separate element from the retainer 3102 and cartridge 3100, whichas mentioned above may be separate elements or may be fixed together asa unit. The adjunct 3106 in such embodiments can thus be configured tobe coupled to the retainer 3102 and cartridge 3100 by a user. Theadjunct 3106 can be coupled to the retainer 3102 and cartridge 3100 inany of a variety of ways. For example, the adjunct 3106 can be manuallyengaged with the retaining elements 3104 by being pressed or slidthereon by hand. For another example, an applicator tool can beconfigured to have the adjunct 3106 loaded thereon, and the applicatortool can be configured to engage the adjunct 3106 with the retainingelements 3104 by sliding or pressing the adjunct 3106 thereon. Use ofthe applicator tool may allow for more predictable engagement of theadjunct 3106 with the retaining elements 3104 than application by hand.

FIG. 18 illustrates another embodiment of the retaining elements 3104engaging the adjunct 3106. In this illustrated embodiment, the retainingelements 3104 catch various ones of interlaced fibers of the adjunct3106 to hold the adjunct 3106 thereto. Some or all of the retainingelements 3104 may therefore not extend above the adjunct 3106, as withthe retaining element 3104 illustrated in FIG. 18.

In other embodiments, the adjunct releasably engaged with the retainingelements 3104 can have a configuration other than a fibrous structure.For example, the adjunct can be a film, and the retaining elements 3104can extend through the film so as to hook the adjunct thereto. The filmmay have pre-formed holes therein at locations where the retainingelements 3104 will extend therethrough.

FIG. 19 illustrates another embodiment of a staple cartridge 3120coupled to a retainer 3122 including a plurality of retaining elements3124 configured to releasably retain an adjunct 3126 to the staplecartridge 3120. The staple cartridge 3120 is generally configured andused similar to the staple cartridge 40 of FIGS. 1 and 2, e.g., has aplurality of staple cavities 3128 in a tissue-facing surface 3130thereof that each seat a staple therein (the staples are obscured inFIG. 19), is configured to have a sled moved therethrough to push thestaples out of the staple cavities 3128, has a longitudinal slot 3122through which a knife or other cutting element can translate to cuttissue, etc. The staple cartridge 3120 is releasably seated in the lowerjaw 3114 of FIG. 15 but can be similarly seated in other types of jaws.The cartridge 3120 in this illustrated embodiment does not have anycut-outs or pockets formed therein, but in other embodiments may have aplurality of cuts-outs similar to the cut-outs 3118 of the cartridge3100 of FIG. 15. The adjunct 3126 is a fibrous structure similar to theadjunct 3106 of FIG. 15 but can have other configurations.

The retainer 3122 is generally configured and used similar to theretainer 3102 of FIG. 15. The retainer 3122 in this illustratedembodiment is in the form of a pan or tray that has a bottom withopposed sidewalls extending upwardly therefrom. The cartridge 3120 isfixedly seated in the retainer 3122, which is seated in a channel in thelower jaw 3114, but can instead be releasably seated in the retainer3122.

The retaining elements 3124 are also generally configured and usedsimilar to the retaining elements 3114 of FIG. 15, e.g., arelongitudinally aligned along opposed sides of the retainer 3122 andalong opposed sides of the cartridge 3120, extend upwardly toward theupper jaw coupled to the lower jaw 3114, etc. However, in thisillustrated embodiment, the retaining elements 3124 are in the form ofpegs that extend upwardly from the retainer 3122. The adjunct 3126 isconfigured to be coupled with the retaining elements 3124 by beingpushed straight down thereon, such as by hand or with an applicatortool. Such loading may be easier than with retaining elements in theform of hooks, since an adjunct may need to be loaded onto hooks at anangle that may generally be less intuitive than a straight down motion.The retaining elements 3124 are integrally formed with the retainer3122, but similar to that discussed above, can be otherwise attachedthereto. In at least some embodiments, one or more of the retainingelements 3124 can include a gripping feature thereon configured tofacilitate gripping of the adjunct 3126, similar to that discussedabove.

FIGS. 20 and 21 illustrate another embodiment of a staple cartridge 3132coupled to a retainer 3134 including a plurality of retaining elements3136 configured to releasably retain an adjunct 3138 to the staplecartridge 3132. The staple cartridge 3132 is generally configured andused similar to the staple cartridge 40 of FIGS. 1 and 2, e.g., has aplurality of staple cavities 3140 in a tissue-facing surface 3142thereof that each seat a staple therein (the staples are obscured inFIG. 20 and have already been deployed in FIG. 21), is configured tohave a sled 3144 moved therethrough to push the staples out of thestaple cavities 3140, has a longitudinal slot 3146 through which a knifeor other cutting element can translate to cut tissue, etc. The sled 3144is shown in a distal position in FIG. 21 after it has slid distally apartial distance along an inner bottom surface 3134 s of the retainer3134 to deploy staples from the cartridge 3132, prior to release of theadjunct 3138, which is discussed further below. The adjunct 3138 is afibrous structure similar to the adjunct 3106 of FIG. 15 but can haveother configurations. The retaining elements 3136 are also generallyconfigured and used similar to the retaining elements 3114 of FIG. 15,e.g., are longitudinally aligned along opposed sides of the retainer3134 and along opposed sides of the cartridge 3132, extend upwardlytoward the upper jaw coupled to the lower jaw 3114, are in the form ofhooks angled proximally, etc.

The staple cartridge 3132 is releasably seated in the lower jaw 3114 ofFIG. 15 but can be similarly seated in other types of jaws. Thecartridge 3132 has a plurality of cut-outs or pockets 3148 formedtherein, as also shown in FIG. 22, that are similar to the cut-outs 3118of the cartridge 3100 of FIG. 15.

The retainer 3134 in this illustrated embodiment is in the form of a panor tray that has a bottom with opposed sidewalls extending upwardlytherefrom. The retainer 3134 is generally configured and used similar tothe retainer 3102 of FIG. 15, but the retainer 3134 in the illustratedembodiment of FIGS. 20-22 is movably seated in the lower jaw 3114. Theretainer 3134 is configured to move relative to the cartridge 3132 andthe lower jaw 3114 to facilitate release of the adjunct 3138. Theretainer 3134 is configured to move from a locked or engagedconfiguration, which is shown in FIGS. 20 and 21, to an unlocked orunengaged configuration, which is shown in FIG. 22. In the lockedconfiguration, the retaining elements 3136 each releasably engage theadjunct 3136, e.g., “lock” the adjunct 3136 to the cartridge 3132. Inthe unlocked configuration, the retaining elements 3136 are eachdisengaged from the adjunct 3136, e.g., the adjunct 3136 is “unlocked”from the cartridge 3132.

The retainer 3134 includes a release element 3150 configured tofacilitate movement of the retainer 3134 from the locked configurationto the unlocked configuration. The release element 3150 is located in adistal portion of the retainer 3134 either at the retainer's distal edgeor, as in this illustrated embodiment, just proximal to the retainer'sdistal edge. In this illustrated embodiment, the release element 3150includes a pair of tabs extending upwardly from the retainer's innerbottom surface 3134 s, although there can be another number of releaseelements. The release element can have other configurations, such as asemi-spherical protrusion on the retainer's inner bottom surface 3134 s,a raised elongate bar on the retainer's inner bottom surface 3134 s, anelongate bar located above the retainer's inner bottom surface 3134 sand extending between opposed inner sides of the retainer 3134, etc.

The release element 3150 is configured to engage the sled 3144 to movethe retainer 3134 from the locked configuration to the unlockedconfiguration. As discussed above, the sled 3144 is configured to slidedistally along the cartridge 3134 and lower jaw 3114 on the retainer'sinner bottom surface 3134 s to deploy the staples through the staplecavities 3140. The staples pierce through the adjunct 3138 as they aredeployed, as also discussed above. The sled 3144 will contact or abutthe release element 3150 as its nears the end of its distal translationalong the cartridge 3134 and lower jaw 3114. Continued distal movementof the sled 3144 with the sled 3144 contacting or abutting the releaseelement 3150 pushes the retainer 3134 distally relative to the cartridge3134 and lower jaw 3114. The retaining elements 3136 attached to theretainer 3134 will thus also move distally. The distal movement of theretaining elements 3136 causes the retaining elements 3136 to slide freeof the adjunct 3138 so as to release the adjunct 3138 therefrom. Thus,unlike the embodiments of the retaining elements 3104, 3124 of FIGS. 15,18, and 19 that are configured to sequentially release the adjunctcoupled thereto in a proximal to distal direction, the retainingelements 3136 are configured to simultaneous release the adjunct 3138.

As shown in FIGS. 20 and 21, the retaining elements 3134 are alignedwith the cartridge's cut-outs 3148 when the retainer 3134 is in thelocked configuration. As shown in FIG. 22, the retaining elements 3134are not aligned with the cartridge's cut-outs 3148 when the retainer3134 is in the unlocked configuration. The adjunct 3136 is thus free toexit the cut-outs 3148 when the retainer 3134 is in the unlockedconfiguration.

The cartridge 3132 can include open space 3152 in a distal portionthereof, as shown in FIG. 21. The retainer 3134 is configured to moveinto the open space 3152 when the retainer 3134 moves distally to movefrom the locked configuration to the unlocked configuration.

The cartridge 3132 can include a stop element in the distal portionthereof configured to contact or abut the retainer 3134 in its lockedconfiguration. The stop element can be configured to stop the distalmovement of the retainer 3134 relative to the cartridge 3132 and lowerjaw 3114. The stop element can have a variety of configurations, such asone or more tabs extending upwardly from an inner bottom surface of thecartridge 3132, a semi-spherical protrusion on the cartridge's innerbottom surface, a raised elongate bar on the cartridge's inner bottomsurface, an elongate bar located above the cartridge's inner bottomsurface and extending between opposed inner sides of the cartridge 3132,etc.

In an exemplary embodiment, the adjunct 3138 is releasably coupled tothe retaining elements 3136 in manufacturing, which may help ensure thatthe retainer 3134 is in a proper location relative to the cartridge 3132prior to staple deployment so the retainer 3134 can appropriately slidedistally to release the adjunct 3138. The adjunct 3138 can, however,instead be manually applied to the retaining elements 3136 by a user.

In another embodiment, instead of the sled 3144 contacting or abuttingthe release element 3150 to push the retainer 3134 distally relative tothe cartridge 3132 and lower jaw 3114, an E-beam that advances distallyalong the cartridge 3132 and lower jaw 3114 can contact or abut therelease element 3150 to push the retainer 3134 distally relative to thecartridge 3132 and lower jaw 3114. In yet another embodiment, both thesled 3144 and an E-beam can contact or abut the release element 3150 topush the retainer 3134 distally relative to the cartridge 3132 and lowerjaw 3114.

In another embodiment, instead of the retainer 3134 including therelease element 3150, the cartridge 3132 can include the release element3150. The retainer can include an opening for the release element toextend through, e.g., one opening for each of a pair of tabs extendingupwardly from the cartridge. The opening and the release element areconfigured to cooperate to help hold the retainer in position relativeto the cartridge until the sled and/or the E-beam contact or abut therelease element and push the retainer distally. The release elementextending from the cartridge can have elasticity to allow the releaseelement to bend during the distal advancement of the retainer so theretainer can at least partially slide over the release element.

In another embodiment, instead of the sled 3144 (and/or the E-beam)contacting or abutting the release element 3150 to push the retainer3134 distally relative to the cartridge 3132 and lower jaw 3114, thesled 3144 (and/or the E-beam) contacting or abutting the release element3150 can move the retainer 3134 in a downward direction such that theretaining elements 3136 move downward and out of engagement with theadjunct 3138. The cartridge's bottom surface can slope downward distalto an initial position of the retainer to guide this downward movementof the retainer.

FIG. 23 illustrates another embodiment of a staple cartridge 3154configured to releasably retain an adjunct 3156. The staple cartridge3154 is generally configured and used similar to the staple cartridge 40of FIGS. 1 and 2, e.g., has a plurality of staple cavities 3158 in atissue-facing surface 3160 thereof that each seat a staple therein (thestaples are obscured in FIG. 23), is configured to have a sled movedtherethrough to push the staples out of the staple cavities 3158, has alongitudinal slot 3162 through which a knife or other cutting elementcan translate to cut tissue, etc. The staple cartridge 3154 isreleasably seated in a lower jaw 3164 of an end effector that isgenerally configured and used similar to the lower jaw 3114 of FIG. 15.

In this illustrated embodiment, the cartridge 3154 includes a pluralityof retaining elements 3166 configured to releasably retain the adjunct3156 to the cartridge 3154. The retaining elements 3166 are in the formof pegs, similar to the retaining elements 3124 of FIG. 19, that extendupwardly from the tissue-facing surface 3160 of the cartridge 3154. Theretaining elements 3166 are arranged in clusters that are longitudinallyaligned along opposed sides 3154 a, 3154 b of the cartridge 3154. Thenumber of retaining elements 3166 in each cluster can vary, but in anexemplary embodiment there are at least three retaining elements 3166 ineach cluster. In an exemplary embodiment there are at least threeclusters of retaining elements 3166 on each side 3154 a, 3154 b of thecartridge 3154. For example, one cluster can be near a proximal end ofthe cartridge 3154 for releasable attachment to the adjunct 3156 near aproximal end thereof, one cluster can be near a distal end of thecartridge 3154 for releasable attachment to the adjunct 3156 near adistal end thereof, and one cluster can be near a middle of thecartridge 3154 for releasable attachment to the adjunct 3156 near amiddle thereof. Any additional clusters can be located between theproximal cluster and the middle cluster and/or between the distalcluster and the middle cluster. Regardless of a number of clusters oneach side 3154 a, 3154 b of the cartridge 3154, the clusters can beequidistantly spaced therealong, as in this illustrated embodiment,which may help evenly secure the adjunct 3156 to the cartridge 3154. Insome embodiments, instead of clusters of retaining elements 3166, theretaining elements 3166 can be individual members aligned longitudinallyalong the cartridge 3154.

The retaining elements 3166 are integrally formed with the cartridge3154 in this illustrated embodiment, such as by being molded therewith.In other embodiments, instead of being integral with the cartridge 3154,the retaining elements 3166 can be separate members attached thereto,such as by welding, adhesive, press fit, etc.

The adjunct 3156 in this illustrated embodiment is a fibrous structurethat is configured to transition from an original, non-contractedconfiguration to a contracted configuration under application of heat.FIG. 24 illustrates the adjunct 3156 in the non-contractedconfiguration, and FIG. 25 illustrates the adjunct 3156 in thecontracted configuration. In general, the adjunct 3156 can be positionedon the cartridge's tissue-facing surface 3160 and heated at least in theareas where the retaining elements 3166 are located. The fibers of theadjunct 3156 can separate to allow the retaining elements 3166 to extendinto the adjunct 3156. The application of heat to the adjunct 3156 isconfigured to cause the adjunct 3156 to transition from thenon-contracted configuration to the contracted configuration. Thecontraction of the adjunct 3156 urges the fibers thereof together togrip the retaining features 3166 and help hold the adjunct 3156 thereto.The contraction of the adjunct 3156 can cause the retaining elements3166 to deform, as shown in FIG. 25 in which the retaining elements 3166have become bent from their straight configuration shown in FIG. 24. Thedeformation of the retaining elements 3166 may help grip the adjunct3156 and thereby help hold the adjunct 3156 on the cartridge 3154 and/ormay facilitate release of the adjunct 3156 since heating the adjunct3156 can make the adjunct 3156 non-flexible. Exemplary embodiments ofcontractable adjuncts and of releasably coupling the adjunct to a membersuch as a staple cartridge or anvil are further described in U.S.application Ser. No. 15/435,891 entitled “Methods And Systems For MatingConstrictable Adjunct Materials With End Effectors” filed on even dateherewith.

The adjuncts 3106, 3126, 3138, 3156 of FIGS. 15, 18-20, and 23 arereleasably coupled to a staple cartridge and a lower jaw that seats thestaple cartridge. In other embodiments, an adjunct can be releasablycoupled to an anvil at an upper jaw of a surgical tool.

FIG. 26 illustrates one embodiment of an upper jaw or anvil 3168 coupledto a retainer 3170 including a plurality of retaining elements 3172configured to releasably retain an adjunct to the anvil 3168. FIG. 27illustrates the anvil 3168 and the retainer 3170 prior to theircoupling. The anvil 3168 is generally configured and used similar to theupper jaw 34 of FIGS. 1 and 2, e.g., has a tissue-facing surface 3174with staple forming pockets 3176 formed thereon, has a longitudinal slot3178 through which a knife or other cutting element can translate to cuttissue, etc. The anvil 3168 includes a coupling mechanism 3178 thatcouples the upper jaw 3168 to a lower jaw of the end effector that isconfigured to cooperate with the upper jaw 3168 to engage and stapletissue, as discussed above.

The retainer 3170 in this illustrated embodiment is in the form of aplate. The retainer 3170 has a longitudinal slot 3180 through which aknife or other cutting element can translate to cut tissue, etc. Theslot 3180 is open at a proximal end thereof to allow the knife or othercutting elements to slide therein. The slot 3180 is thus configured tobe aligned with the anvil's longitudinal slot 3178 when the retainer3170 is coupled to the anvil 3168. The slot 3180 extends along a partiallongitudinal length of the retainer 3170 to allow the retainer 3170 tobe a singular element, e.g., with a connected distal end. In otherembodiments, the retainer 3170 can be a two-piece element with left andright sides providing a space therebetween through which the knife orother cutting element can translate to cut tissue, etc.

The retainer 3170 can be formed from any of a variety of materials. Inan exemplary embodiment, the retainer 3170 is formed from a plastic orpolymer such that the retainer 3170 has elasticity.

The retainer 3170 is configured to releasably couple to the anvil 3168so as to be positioned over the anvil's tissue-facing surface 3174, asshown in FIG. 26. The slot 3180 can be wide enough to not obscure any ofthe staple forming pockets 3176 on the anvil's tissue-facing surface3174 such that staples can be deployed from a lower jaw coupled to theupper jaw 3168, pierce through the adjunct, and be formed by the stapleforming pockets 3176.

The retainer 3170 includes at least one attachment mechanism 3182configured to releasably attach the retainer 3170 to the anvil 3168. Theretainer 3170 being releasably coupled to the anvil 3168 may allow forre-use of the retainer 3170 with different anvils and/or may facilitatecleaning of the retainer 3170 and/or anvil 3168 since the retainer 3170can be removed from the anvil 3168 prior to cleaning of one or both ofthe retainer 3170 and anvil 3168. In other embodiments, the retainer3170 can be fixed to the anvil 3168, which may help ensure that theretaining elements 3172 are in a desirable location relative to theanvil 3168, which may help the adjunct be desirably positioned over theanvil's tissue-facing surface 3174. The attachment mechanism 3182 inthis illustrated embodiment includes a pair of arms. The retainer 3170in this illustrated embodiment including three pairs of arms, but canhave another number of pairs in other embodiments. The arms areconfigured to snap around an exterior of the anvil 3168, as shown inFIG. 26.

The attachment mechanism 3182 is integrally formed with the retainer3170 in this illustrated embodiment. The attachment mechanism 3182 canthus also, in an exemplary embodiment, have elasticity. The attachmentmechanism 3182 having elasticity may help the attachment mechanism 3182snap around the anvil 3168. In other embodiments, instead of beingintegral with the retainer 3170, the attachment mechanism 3182 can be aseparate member attached thereto.

The retaining elements 3172 are in the form of pegs, similar to theretaining elements 3124 of FIG. 19, and extend downwardly from thetissue-facing surface 3174 of the anvil 3168 in a direction toward thelower jaw coupled to the upper jaw 3168. The retaining elements 3172 arearranged in clusters that are longitudinally aligned along opposed sides3170 a, 3170 b of the retainer 3170, similar to the clusters of theretaining elements 3166 of FIG. 23 discussed above. Each of the clustershas two retaining elements 3172 but can have another number. Theretainer 3170 has five clusters along each side 3170 a, 3170 b of theretainer 3170 but can have another number.

The retaining elements 3172 are integrally formed with the retainer 3170in this illustrated embodiment. The retaining elements 3172 can thusalso, in an exemplary embodiment, have elasticity. FIG. 28 illustratesflexing of the retaining element 3172 allowed by the elasticity, withthe retaining element 3172 in phantom showing the retaining element 3172bent. In other embodiments, instead of being integral with the retainer3170, the retaining elements 3172 can be separate members attachedthereto. Also, in other embodiments, the retaining elements 3172 can beintegrally formed with the anvil 3168 or be separate members attachedthereto such that a retainer is not used.

The adjunct releasably coupled to the anvil 3168 can have a variety ofconfigurations, as discussed above. In an exemplary embodiment, theadjunct is a fibrous structure or a film.

FIG. 29 illustrates another embodiment of an upper jaw or anvil 3184coupled to a retainer 3186 including a plurality of retaining elements3188 configured to releasably retain an adjunct to the anvil 3190. FIG.30 illustrates the anvil 3184 and the retainer 3186 prior to theircoupling. The retaining elements 3188 are configured and used similar tothe retaining elements 3172 of FIG. 27 except that in this illustratedembodiment the proximal-most clusters on either side 3186 a, 3186 b ofthe anvil 3184 have three retaining elements 3188 each while a remainderof the clusters have two retaining elements 3188 each.

The retainer 3186 is generally configured and used similar to theretainer 3170 of FIG. 27 except that in this illustrated embodiment theretainer's attachment mechanism 3190 includes a frame. The retainer 3186in this illustrated embodiment including three frames, but can haveanother number of frames in other embodiments. The frames are configuredto slide around an exterior of the anvil 3184 and be seated in recesses3192 formed in the anvil's exterior surface. A distal end 3194 of theanvil 3184 can be advanced in a distal direction through a proximal-mostone of the frames and continue advancing distally until the frames eachalign with respective ones of the recesses 3192, thereby coupling theanvil 3184 and the retainer 3186 together. The anvil 3184 can be movedin a proximal direction relative to the retainer 3186 to remove theanvil 3184 from the retainer 3186. The attachment mechanism 3190 canhave elasticity, as discussed above, which may facilitate seatingthereof in the recesses 3190 as well as facilitate removal of the anvil3168 from the retainer 3186. The anvil 3184 is generally configured andused similar to the anvil 3168 of FIG. 27 except that the anvil 3184 inthis illustrated embodiment includes the recesses 3192 that extendradially around its outer surface.

The adjunct releasably coupled to the anvil 3184 can have a variety ofconfigurations, as discussed above. In an exemplary embodiment, theadjunct is a fibrous structure or a film.

Adjunct Release for Surgical Staplers

Various exemplary devices, systems, and methods for releasably retainingan adjunct material on an end effector of a surgical instrument aredescribed herein. In some implementations, an adjunct material can bereleasably retained on a jaw of an end effector in a manner that reducesor prevents the adjunct material from prematurely slipping off the jaw.In this way, the adjunct can be securely coupled to the end effectorwhile a surgeon manipulates the end effector during a surgicalprocedure. The adjunct material can be coupled to an end effector in avariety of ways, for example by inserting portions of the adjunct intoconnection cavities on a tissue-facing surface of the jaw. In someembodiments, the adjunct can have tags or protrusions that extend froman outward facing surface such that the tags can be configured to bereceived in cavities on the tissue-facing surface of the jaw. In otherimplementations, the adjunct can be coupled to the tissue-facing surfaceof the jaw using an adhesive. The adjunct can remain coupled to the endeffector until it is separated from the end effector and transferred toa treatment site in a patient, for example by a release mechanism thatincludes features and/or components that are configured for releasablyattaching an adjunct thereto. A variety of release mechanisms can beused, such as staple deployment members and/or a cutting element thatcauses the adjunct to separate from the end effector. The releasemechanism can thus allow a user to securely attach an adjunct to an endeffector and allow the user to rapidly deploy the adjunct when desired.

Attaching an adjunct to and releasing an adjunct from an end effectorcan be achieved through a variety of techniques. FIGS. 31-33 illustrateone embodiment of an end effector 4100 having an adjunct releasingmechanism. FIG. 31 illustrates a portion of a lower jaw 4101 of the endeffector 4100, which can be disposed on a distal end of a surgicalinstrument, such as surgical staplers 10, 50 discussed above. The lowerjaw 4101 can have a cartridge 4102 disposed thereon, similar to thestaple cartridge 40, that has a tissue-facing surface 4106 with anadjunct 4104 (only a portion of the adjunct 4104 is shown) disposedthereon, such as one or more of the buttresses, adjuncts, and/ormedicants discussed above.

The cartridge 4102 can have staples disposed in staple cavities 4108which are formed in the tissue-facing surface 4106. The tissue-facingsurface 4106 can also have a channel 4112 configured to receive acutting element, similar to the knife blade 36, as it moves distallytherethrough. One or more connection cavities 4110 can extend betweenand connect the staple cavities 4108 for attaching an adjunct to thecartridge 4102. The connection cavities 4110 can be in the form ofrecesses or bores, and can have a variety of configurations and shapes.For example, the connection cavities 4110 can be roughly oval in shapeand smaller than the staple cavities 4108. In other embodiments, thecavities can be circular, square, rectangular, 3-dimensional shapes,etc., and they can be larger than, equal in size to, or a combination ofsizes relative to the staple cavities 4108. The cavities 4110 can bedisposed between rows of the staple cavities 4108. However, theconnection cavities 4110 can have any number of configurations, such aseach staple cavity 4108 having a connection cavity 4110 adjacentthereto. While the connection cavities 4110 are formed adjacent to thestaple cavities 4108 on the tissue-facing surface 4106, they can beformed elsewhere. For example, the cavities can be formed at theinterface of the cartridge and a tray, similar to tray 37, such thatsome portion of the inner surface of the cavity is a surface of thecartridge, and another portion is a surface of the tray. Furthermore,connection cavities for attaching and detaching an adjunct need not belimited to the tissue-facing surface of the cartridge. For example,connection cavities can be formed along the edge of the tissue-facingsurface of the cartridge such that when the end effector is assembled, aportion of the connection cavity will be formed by a staple tray similarto staple tray 37. Alternatively, rather than connection cavities, achannel can be formed between the tissue-facing surfaces of thecartridge and the tray. Portions of the adjunct can be tucked into thechannel, or adhered to the tissue-facing surface at locations proximalto the channel, during manufacturing or at any time prior to use. Insuch an embodiment, drivers near the outermost edge of the tissue-facingsurface of the cartridge can have an adjunct releasing mechanism suchthat portions of the adjunct are pushed out of the channel, and/or breakthe adhesive bond along the channel between the adjunct and thecartridge during firing.

The adjunct 4104 can be configured to be releasably retained on thetissue-facing surface 4106. The adjunct 4104 can have protrusions ortabs disposed on a surface that contacts the tissue-facing surface 4106,and the protrusions can be configured to extend into and engage with theconnection cavities 4110. The adjunct 4104 can be configured to engagethe tissue-facing surface 4106 through a variety of means. For instance,protrusions on the adjunct can be received in the connection cavitiesand securely attaching due to a friction fit attachment. In such anexample, an adjunct can be created by extruding a film such that it hasprotrusions in predefined locations that correspond to locations of theconnection cavities on a tissue-facing surface of a cartridge. In otherembodiments, the adjunct can be made from a VICRYL® (polyglactin 910)material, and can include one or more backing layers made ofpolydioxanone (PDS). The one or more PDS layers can be fused to theVICRYL® material, and the one or more PDS layers can include protrusionsthat can be configured to extend into and mate with the connectioncavities. In addition or alternatively, the adjunct can engage thetissue-facing surface through use of an adhesive, such as cyanoacrylate.

The cartridge 4102 can have one or more staple drivers 4200, 4300movably disposed therein, similar to staple drivers 48. The stapledrivers 4200, 4300 can be configured to move upward through the staplecavities 4108 to apply an upward force on each of the plurality ofstaples within the cartridge 4102. The staple driver 4200 illustrated inFIG. 32 can have a staple portion 4202 that can have a staple channel4208 formed on an upper end thereon and that can be configured to seat astaple therein, similar to the staple driver 48. The driver 4200 canalso have an adjunct releasing mechanism 4203 attached to a side of thestaple portion 4202 and having a generally L-shaped configuration. Theadjunct releasing mechanism 4203 can have a connecting element 4204 thatconnects the staple portion 4202 to the adjunct releasing mechanism4203. A post 4206 can be attached to the connecting element 4204 and itcan extend upward in the same direction as the staple channel 4208 ofthe staple portion 4202. The connecting element 4204 can have anupward-angled bottom 4205 that is configured to contact a wedge sled,similar to the wedge sled 47, to allow upward movement of the driver4200 and firing of the staples. The post 4206 can have a variety ofshapes, such as a rectangular shape as illustrated in FIG. 32, acylindrical shape, a square, etc. In an exemplary embodiment, the post4206 has a shape that corresponds to a shape of the connection cavity4110 such that the post 4206 can be received in the connection cavity4110.

FIG. 33 illustrates another embodiment of a staple driver 4300 that canbe configured similar to the staple driver 4200. However, staple driver4300 can have first and second staple portions 4302, 4303 similar to thestaple portion 4202 with staple channels 4308, 4310 disposed on upperends of the staple portions 4302, 4303, respectively. Each staplechannel 4308, 4310 can be configured to seat a staple therein, and thestaple driver 4300 can be configured to fire two staples simultaneously.The first and second staple portions 4302, 4303 can have an adjunctreleasing mechanism 4304 coupled therebetween. The adjunct releasingmechanism 4304 can include a connecting element 4305 and a post 4306.The connecting element 4305 extends between and connects the two stapleportions 4302, 4303, and it has an upward-angled bottom 4309 that isconfigured to contact a wedge sled, similar to the wedge sled 47, toallow upward movement of the driver 4300 and firing of the staples. Thepost 4306 is attached to the connecting element 4305 and extends upwardin the same direction as the staple channels 4308, 4310. The post 4306can have a variety of shapes, such as a rectangular shape as illustratedin FIG. 32, a cylindrical shape, a square, etc. In an exemplaryembodiment, the post 4306 has a shape that corresponds to a shape of theconnection cavity 4110 such that the post 4306 can be received in theconnection cavity 4110.

While the illustrated staple drivers 4200, 4300 have connecting elementsbetween the staple portions and the adjunct releasing mechanisms, avariety of connections can be used to connect multiple staple drivers.For example, two connecting elements can be used to connect three stapledrivers. One skilled in the art will appreciate that a connectingelement can include multiple adjunct releasing mechanisms, that multipleconnecting elements can be used in parallel or in series to connectmultiple staple drivers, and that the adjunct releasing mechanisms canhave any number of geometries. For example, the adjunct releasingmechanisms can be curved, or can have cross-sections that are square,circular, triangular, etc. Additionally, it is possible that not all ofthe adjunct releasing mechanisms are uniform. The adjunct releasingmechanisms can have sharp features, as well. For example, the detachmentfeatures can be sharpened such that they can cut away a small portion ofthe adjunct to detach the rest from a tissue-facing surface of acartridge.

In use, the staple drivers 4200 and/or 4300 can be disposed in thecartridge 4102 and aligned with the staple cavities 4108 and theconnection cavities 4110 such that the staple channels 4208, 4308, 4310are aligned with the staple cavities 4108 and the posts 4206, 4306 arealigned with the connection cavities 4110. The cartridge 4102 can beloaded with staples. The adjunct 4104 can be retained on thetissue-facing surface 4106 by, for example, having a plurality ofprotrusions friction fit within the connection cavities 4110. Theadjunct 4104 can be applied to the tissue-facing surface 4106 any timebefore use, such as during manufacture or during preparation for use,and can be applied through a variety of techniques, such as by use of anapplicator.

A surgeon can maneuver the surgical stapler into position and clamptissue between jaws of the end effector 4100 thereon. The surgeon canthen fire the surgical stapler, causing a sled, similar to wedge sled47, to move distally through the cartridge 4102 of the end effector4100. The sled can push one or more of the staple drivers 4200, 4300upwardly through the staple cavities 4108 in the staple cartridge 4102.Upward movement of the staple drivers 4200, 4300 applies an upward forceon each of the plurality of staples within the cartridge 4102 to therebypush the staples upwardly through the adjunct 4104 and tissue andagainst an anvil surface of an upper jaw of the end effector 4100 toform the staples. Upward movement of the staple drivers 4200, 4300 alsomoves the posts 4206, 4306 upwards. The posts 4206, 4306 apply an upwardforce on the protrusions of the adjunct 4104, forcing the protrusionsout of the connection cavities 4110 as distal ends of the posts 4206,4306 enter the cavities 4110. Forcing the protrusions from the cavities4110 releases the adjunct 4104 from the tissue-facing surface 4106, andthe adjunct can be secured by staples to the tissue grasped by the endeffector 4100. In other embodiments, the posts 4206, 4306 can beconfigured to force the protrusions only partially out of the connectioncavities 4110, which can be sufficient to loosen the adjunct 4104 fromthe tissue-facing surface 4106 enough such that the staples will removethe adjunct 4104 entirely upon firing. In various embodiments, firingthe surgical stapler can also cause a cutting element to translatethrough the cartridge 4102 along the channel 4112 to tissue whilestaples are fired and the adjunct 4104 is released.

While the adjunct 4104 can be attached to the cartridge 4102 byprotrusions, as noted above, adjuncts can be attached to a cartridge ofa surgical stapler through a variety of means. For example, FIG. 34illustrates an end effector 4400 with a cartridge 4402 and an adjunct4404 secured thereto by an adhesive. The end effector 4400 can generallyfunction and include components similar to end effector 4100. Forexample, the end effector 4400 can include an upper jaw having an anvil(not shown) and a lower jaw 4401 with the cartridge 4402 engagedthereon.

The cartridge 4402 can have staples 4416 disposed in a plurality ofstaple cavities 4408 and a plurality of connection cavities 4410 formedin a tissue-facing surface 4406. The connection cavities 4410 can have avariety of configurations and shapes. For example, the connectioncavities 4410 can be roughly oval in shape and smaller than the staplecavities 4408. In other embodiments, the connection cavities 4410 can becircular, square, rectangular, etc., and they can be larger than, equalin size to, or a combination of sizes relative to the staple cavities4408. The connection cavities 4410 can be disposed between rows of thestaple cavities 4408. However, the connection cavities 4410 can have anynumber of configurations.

The adjunct 4404 can be configured to be releasably retained on thetissue-facing surface 4406, and the adjunct 4404 can be any of theadjuncts discussed herein. The adjunct 4404 can have adhesive disposedon a surface that contacts the tissue-facing surface 4406. For example,there can be adhesive points 4405 between the adjunct 4404 and thetissue-facing surface 4406 around outer edges of the connection cavities4410 that can be configured to retain the adjunct 4404 on the cartridge4402. However, a variety of different placements of the adhesive points4405 is possible, such as in a grid pattern. Additionally, the adhesivecan be spread uniformly on the tissue-facing surface 4406. A variety ofadhesives can be used, such as cyanoacrylate.

When the adjunct is attached to the cartridge with an adhesive, it canbe desirable in various embodiments to prevent the adhesive fromspilling into the cartridge, for example into a cutting element channelor into the staple cavities. Various adjuncts can be configured toinclude features that prevent or inhibit adhesive from spilling into thecartridge and/or specifically the cutting element channel of thecartridge during the attachment process. As an example, the adhesivepoints 4405 can be formed by including small circular molded features ona surface of the adjunct 4404 that contacts the tissue-facing surface4406 of the cartridge 4404. The circular molded features can act asreservoirs to form adhesive droplet attachment point insuring theadhesive, such as cyanoacrylate, does not enter the cartridge 4402and/or the cutting element channel during attachment. In otherembodiments, the adhesive can be housed within the adjunct itself, orreservoirs for adhesive can be part of an applicator used to apply theadjunct to the cartridge. For example, the reservoirs can be broken aspart of clamping or pulling an activation lever on the applicator.

The cartridge 4402 can have one or more staple drivers 4411 movablydisposed therein, similar to staple drivers 4200, 4300, that can beconfigured to move upward through staple cavities 4408 to apply anupward force on each of the plurality of staples 4416 within thecartridge 4402. Each staple driver 4411 can have a staple portion 4412that can have a staple channel 4413 formed on an upper end thereof thatis configured to seat a staple 4416 therein. The driver 4411 can alsohave an adjunct releasing mechanism attached to a side of the stapleportion 4412 and having a post 4414 that is attached to the stapleportion 4412 and that extends upward in the same direction as the staplechannel 4413 of the staple portion 4412. The staple driver 4411 can havean upward-angled bottom 4409 that is configured to receive a wedge sled4420, similar to the wedge sled 47, to allow upward movement of thedriver 4200 and firing of the staple. The post 4414 can have a varietyof shapes, such as a rectangular shape, a cylindrical shape, a squareshape, etc., and the post 4406 can be configured to be received in theconnection cavities 4410.

In use, the cartridge 4402 can have a plurality of the staple drivers4411 disposed therein and loaded with staples 4416. The adjunct 4404 canbe retained on the tissue-facing surface 4406 by, for example, having aplurality of adhesive points 4405 between the adjunct 4404 and thetissue-facing surface 4406 around the outer edges of the connectioncavities 4410. The adjunct 4404 can be applied to the tissue-facingsurface 4406 any time before use, such as during manufacture or duringpreparation for use, and can be applied through a variety of techniques,such as by use of an applicator. A surgeon can maneuver the surgicalstapler into position and clamp tissue between jaws of the end effector4400 thereon. The surgeon can then fire the surgical stapler, causingthe sled 4420 to move distally through the cartridge 4402 of the endeffector 4400. The sled 4420 can push one or more of the staple drivers4411 upwardly through the staple cavities 4408 in the staple cartridge4402. Upward movement of the staple drivers 4411 applies an upward forceon each of the plurality of staples 4416 within the cartridge 4402 tothereby push the staples upwardly through the adjunct 4404 and tissueand against an anvil surface of the upper jaw of the end effector 4400to form the staples. Upward movement of the staple drivers 4411 alsomoves the posts 4414 upwards. The posts 4414 can apply an upward forceon the adjunct 4404, forcing the adjunct 4404 to move upwards andbreaking the adhesive points 4405 once the posts 4414 move sufficientlythrough the connection cavities 4411. For example, the adhesive points4405 can hold firm until a distalmost end of the posts 4414 crosses aplane of the tissue-facing surface 4406. Breaking, cracking, orseparating the adhesive points 4405 from between the adjunct 4404 andthe tissue-facing surface 4406 releases the adjunct 4404 from thetissue-facing surface 4406, and the adjunct 4404 can be secured by thestaples 4416 to the tissue grasped by the end effector 4400. Although adistalmost end of the posts 4414 can cross a plane of the tissue-facingsurface 4406, the posts 4414 can be configured such that they onlyextend even with, or below, the tissue-facing surface 4406. In someembodiments, firing the surgical stapler can also cause a cuttingelement to translate through the cartridge 4402, cutting tissue whilethe staples 4416 are fired and the adjunct 4404 is released.

While an adjunct can be attached to a lower jaw as illustrated above, anadjunct can also be attached to components of the upper jaw, such as theanvil. The upper jaw can be similar to that shown in FIGS. 1-2, but caninclude features and/or components for attaching and detaching anadjunct. For example, the upper jaw can be configured to includeconnection cavities and drivers that are driven by an E-beam to causethe adjunct to detach from the jaw. In various embodiments, whenstapling is initiated, the components of the lower jaw can function todrive staples through tissue and the adjunct, while the drivers in theupper jaw can function to detach the adjunct from the anvil.

End Effector Having Extension Features for Mating with Adjuncts

Various exemplary techniques for releasably retaining an adjunctmaterial on one or both jaws of an end effector of a surgical instrumentare described herein. One or both of the opposed jaws can have extensionelements formed thereon that extend beyond a nominal perimeter of thatjaw. The extension elements are formed outside an area of the jaw'stissue-contacting and treating surface having staple-holding cavities(if the jaw is a cartridge body) or a tissue-contacting surface havingstaple-forming cavities (if the jaw is an anvil). An adjunct materialconfigured to be releasably retained on the jaw can have a shapecomplementary to that of the jaw.

In some implementations, an end effector for a surgical instrument hasfirst and second jaws, at least one of which is movable relative to theother one between open and closed positions. For example, the first jawcan have a cartridge body having on a tissue-contacting surface thereofa plurality of staple cavities configured to seat staples therein. Thefirst jaw can have a generally rectangular nominal perimeter defining aregular perimeter around outer rows of the plurality of staple cavities.The second jaw can have or can be an anvil with a plurality of stapleforming cavities formed on a tissue-contacting surface thereof. Thesecond jaw can also have a generally rectangular nominal perimeteropposed to the nominal perimeter of the first jaw.

At least one of the first and second jaws can have a plurality ofattachment features formed thereon on extension elements extendingbeyond the nominal perimeter of the at least one jaw. Each of theextension elements can have at least one attachment feature formedthereon. For example, the attachment feature can be a projectionextending from the corresponding extension element. The attachmentfeature is configured to mate with a corresponding mating feature formedon an adjunct material that has a shape complementary to a shape of thejaw.

FIGS. 35, 36, 37, and 38 illustrate an example of an end effector 5100of a surgical instrument configured to be coupled to a distal end of anelongate shaft of the surgical instrument (not shown). The end effector5100 has a first jaw in the form a cartridge body 5102 and a secondopposed jaw in the form of an anvil 5104 that are configured to clamptissue therebetween. At least one of the cartridge body 5102 and theanvil 5104 is movable relative to the other between open and closedpositions. In some embodiments, the cartridge body 5102 can seat thereina removable and replaceable cartridge. Furthermore, in some embodiments,the cartridge body 5102 can be part of a disposable loading unit coupleddistally to an elongate shaft of a surgical instrument. One or both ofthe jaws of the end effector can have an implantable adjunct materialreleasably retained thereon. For example, the cartridge body 5102 canhave an adjunct material 5101 shown in FIG. 38 releasably retainedthereon as discussed in more detail below.

The cartridge body 5102 has a tissue-contacting surface 5106 having aplurality of staple cavities 5108 (shown partially in FIGS. 36 and 37)configured to seat staples therein. The tissue-contacting surface 5106can have an adjunct material disposed thereon and may therefore notdirectly contact tissue. Moreover, the tissue-contacting surface 5106 isalso a tissue-treating surface. The anvil 5104 has a plurality of stapleforming cavities formed on a tissue-contacting (and treating) surfacethereof, which are obscured in FIG. 35. In this example, both thecartridge body 5102 and the anvil 5104 are generally rectangular. Asschematically shown in FIG. 36, the cartridge body 5102 has alongitudinal axis 5A1 and a generally rectangular nominal perimeter 5110defining a regular perimeter around outer rows of the plurality ofstaple cavities 5108. The nominal perimeter 5110 has long sides 5112 a,5112 b extending along the longitudinal axis 5A and short sides 5114 a,5114 b. The anvil 5104 can also have a generally rectangular nominalperimeter opposed to the nominal perimeter 5114 of the cartridge body5102.

In the example illustrated, the cartridge body 5102 has multipleextension elements 5118 extending beyond the nominal perimeter 5110. Inparticular, as shown in FIG. 35, the extension elements 5118 protrudefrom the cartridge body 5102 such that they extend beyond the side wallsof the cartridge body 5102, such as a sidewall 5115 in FIGS. 35-37. Asshown, the extension elements 5118 are formed outside the area of thecartridge body 5102 having the staple holding cavities 5108. In thisexample, six extension elements 5118 a, 5118 b, 5118 c, 5118 d, 5118 e,5118 f are shown formed on the cartridge body 5102. As shown in FIG. 36,the extension elements 5118 are formed along at least one of the longsides 5112 a, 5112 b of the nominal perimeter 5114, in the plane of thetissue-contacting surface 5106 of the cartridge body 5102. Inembodiments in which the cartridge body 5102 is in the form of a channelconfigured to removably and replaceably sit therein a cartridge withstaples, the extension elements are formed on a body of the channel. Inembodiments in which the entire cartridge body 5102 is removable andreplaceable (e.g., as part of a disposable loading unit), the extensionelements are formed on the cartridge body 5102.

As shown, the distal-most extension elements 5118 a, 5118 d are formedon opposite sides from a knife channel 5105 (FIG. 36) at a distal end5102 d of the cartridge body 5102, adjacent to a distal tip 5103. Theextension elements 5118 b, 5118 e are formed more proximally on bothsides of the knife channel 5105, and the extension elements 5118 d, 5118f are the closest to the proximal end 5102 p of the cartridge body 5102.In this example, the pairs of extension elements formed at opposed sidesfrom the knife channel 5105 (e.g., the extension elements 5118 a, 5118d) can be disposed along the same axis, which can be perpendicular tothe longitudinal axis 5A1 of the jaw 5102. The extension elements formedalong the same side of the jaw can be spaced equidistantly from oneanother along the side of the jaw, or one or more of the extensionelements can be spaced differently from other extension elements.

The extension elements 5118 can have a number of differentconfigurations. In the example illustrated, the extension elements 5118have a trapezoidal shape (e.g., of an isosceles trapezoid) with itslonger base being the closest to the nominal perimeter of the cartridgebody 5102. However, it should be appreciated that the extension elementsformed on the cartridge body can be rectangular, square, semi-circular,or they can have any other suitable shape(s), including regular andirregular shapes. Also, the cartridge body can have extension elementsof two or more different configurations and/or sizes.

Furthermore, six extension elements 5118 a, 5118 b, 5118 c, 5118 d, 5118e, 5118 f are shown by way of example only, as any suitable number ofextension elements can extend beyond the nominal perimeter of thecartridge body. For example, one, two, three, four, five, or greaterthan six extension elements can be formed. Also, a different number ofextension elements can be formed on one long side 5112 a of thecartridge body 5102 as compared to the cartridge body's another longside 5112 b.

As in the implementation shown in FIGS. 35-37, the extension elementscan be formed in the plane that is parallel to the tissue-contactingsurface 5106 of the cartridge body 5102. However, in otherimplementations, one or more of the extension elements can have at leasta portion thereof formed at an angle to the tissue-contacting surface5106 of the cartridge body 5102, in a manner that does not interferewith proper operation of the end effector. The extension elements 5118a, 5118 b, 5118 c, 5118 d, 5118 e, 5118 f can be formed monolithicallyand/or integrally with the cartridge body 5102. Furthermore, in someembodiments, the extension elements can be separate features coupled tothe cartridge body 5102 in a suitable way.

The cartridge body 5102 and the extension elements 5118 have a size suchthat the cartridge body 5102 with the cartridge body 5102 with theextension elements 5118 extending therefrom fit within a trocarproviding access to a surgical site. For example, in the illustratedembodiments, the cartridge body 5102 with the extension elements 5118 issized such that the end effector 5100 has an overall diameter smallerthan 12.8 mm. As a person skilled in the art will appreciate, regardlessof the specific configuration of the cartridge body or anvil, theextension elements are formed thereon such that the end effector can fitwithin a suitable surgical site access instrument.

As shown in FIGS. 35-37, the extension elements 5118 a, 5118 b, 5118 c,5118 d, 5118 e, 5118 f have respective attachment features 5120 formedthereon. In this example, each of the extension elements 5118 a, 5118 b,5118 c, 5118 d, 5118 e, 5118 f has a respective one of the attachmentfeatures 5120 a, 5120 b, 5120 c, 5120 d, 5120 e, 5120 f formed thereon.Each of the attachment features can be in the form of a post or aprojection extending from a respective extension element perpendicularto the longitudinal axis 5A1 of the cartridge body 5102. The projectioncan have a rounded tip or a tip having other suitable configuration.However, it should be appreciated that the attachment features formed onthe extension elements 5118 can have any other various configurations.Also, in some implementations, the jaw (e.g., the cartridge body 5102)can have attachment features of more than one type formed thereon.

One or both of the cartridge body 5102 and anvil 5104 can have anadjunct material (or “adjunct”) releasably retained thereon. In theillustrated implementation, the adjunct material has a shapecomplementary to a shape of the jaw on which it is mounted and theadjunct material is configured to releasably mate with the attachmentfeatures formed on the extension elements of the jaw. Thus, the adjuncthas a generally rectangular nominal perimeter with discrete extensionelements that extend beyond the nominal perimeter in a plane parallel toa surface of the adjunct configured to contact tissue. The extensionelements can be formed on the adjunct such that at least two extensionelements are formed along each of long sides of the adjunct's nominalperimeter. Each of the extension elements can have at least one matingfeature configured to mate with a respective attachment features formedon the jaw.

FIG. 38 shows the adjunct material 5101 that can be releasably retainedon the tissue-contacting surface 5106 of the cartridge body 5102. Asshown in FIG. 38, the adjunct material 5101 has a shape that correspondsto the shape of the cartridge body 5102—extension elements 5128, such aselements 5128 a, 5128 b, 5128 c, 5128 d, 5128 e, 5128 f are formed thatextend beyond a nominal perimeter 5127 in a plane parallel to a surfaceof the adjunct 5101 configured to contact tissue. The extension elements5128 can be formed integrally with the adjunct material 5101 or they canbe separate elements coupled to the adjunct 5101 along the nominalperimeter 5127 thereof in a suitable manner.

The extension elements 5128 a, 5128 b, 5128 c, 5128 d, 5128 e, 5128 fare configured to be disposed over the respective extension elements5118 a, 5118 b, 5118 c, 5118 d, 5118 e, 5118 f extending beyond thenominal perimeter 5110 of the cartridge body 5102. Thus, the shape ofthe adjunct 5101 is such that it “traces” the shape of the cartridgebody 5102. The size of the adjunct material 5101 also corresponds to thesize of the cartridge body 5102. In this way, the adjunct material 5101is aligned with the cartridge body 5102 when the adjunct 5101 isdisposed thereon.

The adjunct material 5101 can be configured to mate with the cartridgebody 5102 in a variety of different ways. In the example illustrated, asshown in FIG. 38, the adjunct material 5101 has a plurality of matingfeatures 5130, such as mating features 5130 a, 5130 b, 5130 c, 5130 d,5130 e, 5130 f that are complementary to the attachment features 5120 a,5120 b, 5120 c, 5120 d, 5120 e, 5120 f formed on the cartridge body 5102and are configured to releasably mate with the attachment features 5120a, 5120 b, 5120 c, 5120 d, 5120 e, 5120 f. In the illustratedimplementation, the mating features are in the form of through openingsformed in the adjunct material 5101. The openings are configured so asto receive the projections therein, such that the adjunct material canbe released from the engagement with the jaw when staples are ejectedfrom staple cavities.

The mating features 5130 a, 5130 b, 5130 c, 5130 d, 5130 e, 5130 f areformed on the adjunct's extension elements 5128 a, 5128 b, 5128 c, 5128d, 5128 e, 5128 f as shown in FIG. 38, at locations on these extensionelements corresponding to the locations of the cartridge's attachmentfeatures 5120 a, 5120 b, 5120 c, 5120 d, 5120 e, 5120 f. In this way,when the adjunct material 5101 is superimposed over the cartridge body5102, the mating features 5130 a, 5130 b, 5130 c, 5130 d, 5130 e, 5130 falign with the cartridge's attachment features 5120 a, 5120 b, 5120 c,5120 d, 5120 e such that each opening receives therein a correspondingprojection. The cartridge's attachment features and adjunct's matingfeatures can releasably mate via a friction fit or in other ways.

As shown in FIG. 35 illustrating a partially transparent view of theanvil 5104, the anvil 5104 can also have extension elements 5122, suchas elements 5122 a, 5122 b, 5122 c, 5122 d, 5122 e, 5122 f, formedthereon that beyond the nominal perimeter 5124 thereof. Each of theextension elements 5122 can have a shape and size similar to that of theextension elements 5118 formed on the cartridge body 5102. For example,as illustrated, the extension elements 5122 can be generallytrapezoidal, though they can have other shapes, as the describedtechniques are not limited in this respect. Similar to the cartridgebody 5102, each of the extension elements 5122 can have a respectiveattachment feature 5126 thereon for mating with an adjunct to bereleasably retained on the anvil 5104. FIG. 35 illustrates that each ofthe extension elements 5122 a, 5122 b, 5122 c, 5122 d, 5122 e, 5122 fcan have a respective one of the attachment features 5126 a, 5126 b,5126 c, 5126 d, 5126 e, 5126 f formed thereon.

In the illustrated implementation, the extension elements 5122 areformed on the anvil 5104 in a manner such that they do not overlap withthe extension elements 5118 formed on the cartridge body 5102. Thus, asshown in FIG. 35 and additionally in FIG. 37 (where a shadow orfootprint 5134 of the anvil 5104 is schematically shown superimposedover the cartridge body 5102), the extension elements 5122 are staggeredwith respect to the extension elements 5118.

In the described embodiments, the respective extension elements areformed on the cartridge body 5102 and the anvil 5104 such that, when theend effector 5100 is in the closed position, the cartridge body'sextension elements 5118 extend beyond the nominal perimeter of the anvil5104 and the anvil's extension elements 5122 extend beyond the nominalperimeter of the cartridge body 5102. For example, FIG. 39, showing theend effector 5100 in a closed configuration, illustrates that thefootprint of the cartridge body 5102 is outside the footprint of theanvil 5104 and that the extension elements 5122 a, 5122 b, 5122 c, 5122d, 5122 e, 5122 f are staggered with respect to the extension elements5118 a, 5118 b, 5118 c, 5118 d, 5118 e, 5118 f However, it should beappreciated that, in some implementations, all or some of thecartridge's and anvil's extension elements are not staggered withrespect to one another. For example, the cartridge's and anvil'sextension elements can be formed symmetrical, such that at least one ofthe anvil's extension elements overlaps with at least one of thecartridge's extension elements.

FIG. 40 additionally illustrates an end effector 5200 having alongitudinal axis 5A2, which can have a configuration similar to that ofthe end effector 5100 (FIGS. 35-37 and 39). Thus, similar to the endeffector 5199, the end effector 5200 has extension elements formed, inthe example of FIG. 40, on both of the jaws 5202 (cartridge body) and5204 (anvil). The extension elements formed on the cartridge body 5202and anvil 5204 are collectively identified as extension elements 5206,5208, respectively. In this example, each of the cartridge body 5202 andanvil 5204 releasably retain thereon respective adjunct materials 5212,5214 that are separately shown in FIGS. 41 and 42. The cartridge'sextension elements 5206 and anvil's extension elements 5208 haveattachment features, such as projections, configured to mate withcorresponding mating features (e.g., openings) formed on adjunctmaterials 5212, 5214, respectively.

As shown in FIGS. 40-42, the adjunct materials 5212, 5214 have shapescomplementary to shapes of the cartridge body 5202 and anvil 5204,respectively. In this example, the extension elements 5206 formed on thecartridge body 5202 are staggered with respect to the extension elements5208 formed on the anvil 5204. In a similar manner, the extensionelements of the adjunct material 5212 are staggered with respect to theextension elements the adjunct material 5214. Thus, FIGS. 41 and 42illustrate that, while the anvil's adjunct material 5214 has extensionfeatures 5224 a, 5224 b along an axis 5B1 (also shown in FIG. 40), thecartridge body's adjunct material 5212 does not have any extensionelements formed along the axis 5B1. However, the cartridge body'sadjunct material 5212 has extension elements 5222 a, 5222 b formed alongan axis 5B2 (also shown in FIG. 40), whereas the anvil's adjunctmaterial 5214 does not have extension elements formed along the axis5B2.

An implantable adjunct configured to be releasably retained over a jawof an end effector can be made from a variety of different materialsdescribed herein. For example, as discussed above, the adjunct can beformed from one or more of a film, foam, an injection moldedthermoplastic, a vacuum thermoformed material, a fibrous structure, andhybrids thereof. The adjunct can also include one or morebiologically-derived materials and one or more drugs. Furthermore, inthe described implementations, one or more portions of the adjunct canhave different properties. For example, the areas configured to besuperimposed over the extensions features formed on a jaw can beconfigured differently from other areas of the adjunct.

A jaw (such as a cartridge body or an anvil) having extension elementsand an adjunct material having a shape complementary to that jaw canhave other features formed thereon for mating between these components.For example, in some implementations, the jaw can have attachmentfeatures in the form of recesses, through openings, or other types offeatures formed in the corresponding extension elements of the jaw andconfigured to mate with respective features formed on the adjunctmaterial.

In some implementations, the opposed jaws of the end effector can havedifferent types of adjunct materials releasably retained thereon.Furthermore, the same or different types of adjunct materials can becoupled to the opposed jaws using the same or different techniques. Forexample, one adjunct material can be attached to one of the jaws viamechanical features (e.g., projections on the jaw and openings on theadjunct, as discussed above), whereas another adjunct material can beattached to the opposed jaw using a suitable adhesive material.

In some embodiments, a cartridge body (e.g., part of a reloadable unit)can have an adjunct material attached thereon via an adhesive material,while another adjunct material can be attached to the anvil usingmechanical feature, such as the projections on the jaw and openings onthe adjunct. The cartridge body can be manufactured with a suitableadjunct material already retained thereon. At the same time, an adjunctmaterial can be attached to the anvil of an end effector during surgery.

In some implementations, the anvil of an end effector can have matingfeatures in the form of female features formed on the extensions of theanvil extending beyond the anvil's nominal perimeter. The femalefeatures, configured to mate with complementary features formed in anadjunct material configured to be releasably retained on the anvil, canbe shaped as openings, pockets, cleats, etc. The adjunct material'smating features can be, for example, hooks, snaps, barbs, featureshaving expandable elements (e.g., tree- or umbrella-like features) thatcan releasably mate with the pocket-type openings in the anvil.Furthermore, in some implementations, the anvil can have one or morethree-dimensional pockets that allow an overmold feature of the adjunctto be releasably retained thereon. The overmold feature can be, forexample, a projection molded into the three-dimensional pocket. Itshould be appreciated that at least on of the jaws of the end effectorand an adjunct configured to releasably mate with that jaw can also havethese features additionally or alternatively to the features describedin connection with FIGS. 35-42.

Furthermore, in some embodiments, one or both of the jaws of the endeffector may not have extension features formed thereon. In suchembodiments, attachment features can be formed on an end effector's jawwithin a nominal perimeter of the jaw. FIGS. 43 and 44 illustrate anexample of such an embodiment providing an anvil 5300 of an end effectorhaving female features formed thereon for mating with an adjunctmaterial 5310 that has corresponding mating features. The anvil 5300 hasa tissue-contacting surface 5302 having a plurality of staple-formingpockets or cavities 5304. The staple-forming cavities 5304 can formvarious patterns on the tissue-contacting surface 5302. In this example,the staple-forming cavities 5304 are arranged in six rows extendingalong a longitudinal axis 5A3 of the anvil 5300. As shown in FIG. 43,the tissue-contacting surface 5302 has attachment features 5316 a, 5316b, 5316 c, 5316 d formed at a distal end 5300 d of the anvil 5300between adjacent staple-forming cavities. As shown, in this example, theattachment features 5316 a, 5316 b, 5316 c, 5316 d are formed in a rowthat is generally perpendicular to a longitudinal axis 5A3 of the anvil5300.

FIG. 44 illustrates by way of example two adjacent staple-formingcavities 5312 a, 5314 a having the attachment feature 5316 atherebetween, which is in the form of an overmold cleat or pocket. Thus,the attachment feature 5316 a and other similar attachment features areformed on the anvil's tissue-contacting surface 5302 by overmolding asuitable polymeric material (or a polymer blend or a copolymer) betweenadjacent staple-forming cavities at selected locations on thetissue-contacting surface 5302. The attachment features 5316 b, 5316 c,5316 d, as well as other attachment features formed on thetissue-contacting surface 5302, can be formed in a similar manner andare not shown in detail.

FIG. 44 also illustrates that the adjunct material 5310 (which is shownpartially in FIG. 43) has a mating feature 5318 a configured to bereceived within the pocket 5316 a. The mating feature 5318 a can be inthe form of an expandable (e.g., umbrella-like) mating feature extendingthrough a thickness of the adjunct 5310 and a portion of which expandsupon being inserted into the pocket 5316 a. The pocket 5316 a and themating feature 5318 a are configured to mate such that, when staples areejected from a cartridge and formed against the staple-forming cavities,the mating features 5318 a are caused to be disengaged from the pocket5316 a.

As shown in FIG. 44, the mating feature 5318 a can be associated withthe adjunct such that its top portion 5319 seats on one side above thesurface of the adjunct 5310, its mid-portion 5321 penetrates through theadjunct's surface and extends toward the opposite side of the adjunctthat comes in contact with the anvil's tissue-contacting surface 5302,and its expandable bottom portion 5323 is disposed on the opposite sideof the adjunct, within the pocket 5316 a. The expandable portion 5323 ofthe mating feature 5318 a can have one or more portions (e.g., arms,wings, prongs, snaps, etc.) that are configured to expand when load isapplied to the top portion 5319.

In use, the adjunct material 5310 is brought in proximity to thetissue-contacting surface 5302 and force can be applied to the adjunctmaterial 5310 to cause the mating feature 5318 a to be received withinthe pocket 5316 a such that the expandable portion 5323 is receivedwithin the pocket 5316 a and expands to thereby releasably retain theadjunct 5310 over the tissue-contacting surface 5302. It should beappreciated that the mating feature 5318 a can have other configurationsthat allow this feature to be used to releasably retain the adjunct onthe jaw. The adjunct's mating features can have a changeableconfiguration, e.g., such that at least a portion of the featureexpands, as the exemplary mating feature 5318 a in FIG. 44. As anothervariation, the mating feature can be in the form of a hook or othernon-expandable feature configured to be received within a recess in ajaw. The load can be applied to the adjunct 5310 manually, or using aloader or applicator member which can be removably coupled to the endeffector or removably coupled to the adjunct 5310. In some embodiments,the adjunct 5310 can have an applicator (e.g., in the form of a frame ofa suitable configuration disposed over the adjunct) for applying loadthereto to be coupled to the adjunct 5310. During a surgical procedure,such applicator can be utilized to cause the adjunct 5310 to bereleasably retained over the jaw.

FIG. 43 shows that, besides the attachment features 5316 a, 5316 b, 5316c, 5316 d, the tissue-contacting surface 5302 also attachment features5320 a, 5320 b, 5320 c, 5320 d formed at a mid-portion 5300 m of theanvil 5300. The tissue-contacting surface 5302 also has attachmentfeatures 5322 a, 5322 b, 5322 c, 5322 d formed at a proximal portion5300 p of the anvil 5300, the locations of which are shown schematicallyin FIG. 43 as these features are obscured by the adjunct 5310.Additionally, the tissue-contacting surface 5302 has proximal-mostattachment features 5324 a, 5324 b (obscured by the adjunct 5310), whichlocations are shown in FIG. 43. The attachment features 5324 a, 5324 bare disposed at opposite sides of an anvil knife channel 5308 extendingbetween distal and proximal ends 5300 d, 5300 p of the anvil 5300.

The mid-portion attachment features 5320 a, 5320 b, 5320 c, 5320 d andthe proximal attachment features 5322 a, 5322 b, 5322 c, 5322 d arearranged in two respective rows generally perpendicular to thelongitudinal axis 5A3 of the anvil 5300. As in this example, theattachment features can be located symmetrically with respect to theanvil knife channel 5108. Regardless of its specific location, each ofthe attachment features is configured to releasably mate with at leastone mating feature formed on the adjunct material. Thus, FIG. 43schematically shows that the proximal attachment features 5322 a, 5322b, 5322 c, 5322 d (obscured in FIG. 43) are configured to mate withrespective adjunct's mating feature collectively indicated as features5326. These mating features can be configured similar to the feature5318 a shown in FIG. 44, or in another way.

It should be appreciated that the attachment features in FIG. 43 areshown to form three rows by way of example only, as attachment featurescan be formed on a tissue-contacting surface of a jaw at any desiredlocations, so as to form various patterns. Also, eight attachmentfeatures are shown by way of example, as any number of the attachmentfeatures can be formed on the jaw's tissue-contacting surface.Furthermore, although the anvil 5300 is shown in FIGS. 43 and 44, insome implementations, features similar to those shown in FIGS. 43 and 44can be formed on a cartridge body of an end effector. Also, thecartridge body and the anvil of an end effector can have respectiveadjuncts releasably coupled thereto via different techniques. Forexample, the cartridge body can have extension elements with attachmentfeatures as shown in FIGS. 35-37 (and in FIGS. 39 and 40), whereas theanvil can have openings or pockets as shown in FIGS. 43 and 44, or viceversa.

Methods and Systems for Mating Constrictable Adjunct Materials with EndEffectors

Various exemplary devices, systems, and methods for releasably retainingan adjunct material on one or both jaws of an end effector of a surgicalinstrument are described herein. One or both of the opposed jaws canhave retaining members formed thereon that are configured to mate withan adjunct material.

In some implementations, an adjunct material can be releasably retainedon a jaw of an end effector in a secure manner, such that a possibilityof the adjunct material prematurely slipping off the jaw is decreased oreliminated. In this way, the adjunct is securely coupled to the jawwhile a surgeon manipulates the end effector during a surgicalprocedure. The adjunct remains coupled to the jaw until it is separatedfrom the jaw and transferred to a treatment site in a patient, forexample, when staples are deployed and/or when movement of a cuttingelement causes the adjunct to separate from the jaw. In suchimplementations, the adjunct material can be coupled to a jaw of an endeffector using one or more contractible attachment features. Thecontractible attachment features, which are configured to couple theadjunct material with retaining members or other features of the jaw,can be features formed separately from the adjunct material.Additionally or alternatively, the contractible attachment features canbe interwoven into or otherwise coupled to adjunct material.

In some embodiments, the contractible attachment feature can be in theform of one or more strands of a shrinkable polymer. The strands can bedisposed on the adjunct material and/or they can be passed through theadjunct material in one or more locations. Furthermore, in someembodiments, the attachment feature can be in the form of a plurality ofpolymer strands interwoven into the adjunct material. The attachmentfeatures can be formed from any suitable material(s). For example, insome implementations, they can be formed from polydioxanone (PDO) orfrom other material(s) having a melting temperature that is lower thanthat of the adjunct material.

Regardless of the specific configuration of the contractible attachmentfeatures and the materials from which they are formed, each attachmentfeature can be configured to be transitioned from an original,non-contracted configuration to a contracted configuration underapplication of heat. The attachment feature can be engaged with theadjunct material, and contraction of the attachment feature is effectiveto couple the adjunct material with retaining members formed on the jaw.Adjunct materials can be releasably coupled to one or both jaws of anend effector of a surgical instrument using the contractible attachmentfeatures described herein.

FIG. 45 illustrates an example of a jaw of an end effector that has anadjunct material releasably secured thereto using contractibleattachment features. FIG. 45 shows a portion of an end effector 6100 ofa surgical instrument configured to be coupled to a distal end of anelongate shaft of the surgical instrument (not shown). The end effector6100 can generally include components similar to those described withregard to FIGS. 1-4, and can also include features and/or componentsthat enable adjuncts to be releasably attached thereto. Thus, similar tosurgical staplers 10 (FIG. 1) and 50 (FIG. 4), the end effector 6100includes an upper jaw having an anvil and an lower jaw having acartridge body (not shown), with only the upper jaw 6102 being shown inFIG. 45. The lower jaw can generally include a staple cartridge that hasa plurality of staple-holding cavities configured to seat staplestherein, the staple-holding cavities opening on a tissue-facing surfaceof the cartridge.

As shown in FIG. 45, the upper jaw 6102 having an anvil 6104 can have anadjunct material 6124 (shown partially transparent) releasably retainedon a tissue-facing surface 6118 of the anvil 6104 using one or morecontractible attachment features 6128, as discussed in more detailbelow. As schematically shown in FIG. 45, the anvil 6104 hasstaple-forming cavities 6116 formed on the tissue-facing surface 6118thereof. As also shown, the tissue-facing surface 6118 has a knifechannel 6108 configured to receive a cutting element (e.g., a knife) asit moves distally therethrough.

In the example illustrated, the anvil 6104 is shown in the form of amodular jaw that includes an anvil plate 6106 releasably attached to theanvil 6104 via an adapter 6110. The anvil plate 6106 is a substantiallyrigid surface against which staples can be formed. In the illustratedexample, the adapter 6110 can include mating features 6112 configured tomate with corresponding anvil features 6114 formed along a side of theanvil 6104 facing the opposed jaw, thereby ensuring an alignment betweenthe anvil plate 6106 and the cartridge-facing surface of the anvil 6104.The adapter 6110 can be, e.g., an elastomer or other compliant member,and it can be overmolded, adhered to, or otherwise coupled to the anvilplate. The adapter 6110 can be used to releasably couple the anvil plate6106 to the anvil 6104 in a variety of ways. For example, the adapter6110 can snap into the jaw 6102. The modular configuration can allowinterchangeably using anvil plates having different staple-formingfeatures with the same jaw. The described techniques can be used inconjunction with various end effectors having modular jaws. For example,such end effectors are described in U.S. patent application Ser. No.15/435,986 entitled “Surgical End Effector Adjunct Attachment,” filed oneven date herewith, and U.S. patent application Ser. No. 15/385,953entitled “Methods of Stapling Tissue” filed on Dec. 21, 2016, the entirecontents of which are incorporated by reference herein.

In the example of FIG. 45, the tissue-facing surface 6118 is in the formof the surface of the anvil plate 6106 facing the adjunct material 6124.However, it should be appreciated that the modular anvil 6104 having theanvil plate 6106 is shown by way of example only, and that the describedtechniques can be used to releasably couple an adjunct material to anytype of a jaw, including a jaw having a tissue-facing surfacenon-removably coupled thereto.

Regardless of its particular configuration, the tissue-facing surface6118 of the anvil 6104 has at least first and second retaining members6122 a, 6122 b that are configured to couple the adjunct material 6124to the anvil 6104. The first retaining member 6122 a is disposed at oneside of the tissue-facing surface 6118 in proximity to one edge 6109 aof the tissue-facing surface 6118, and the second retaining member 6122b is disposed at another, opposed side of the tissue-facing surface 6118in proximity to another, opposed edge 6109 b thereof. In this way, thefirst and second retaining members 6122 a, 6122 b are disposed atopposed sides of the knife channel 6108.

The retaining members 6122 a, 6122 b can have a variety of differentconfigurations. In the example illustrated, they are in the form ofgenerally cylindrical posts extending from the tissue-facing surface6118. However, the retaining members 6122 a, 6122 b can have othershapes, as the described implementations are not limited in thisrespect. For example, the retaining members can have an hour glassshape, a bulbous or widened end region, or any other shape. Additionallyor alternatively, the retaining members can be curved and/or angled inany suitable manner. For example, as shown in FIG. 45, the retainingmembers 6122 a, 6122 b can be slightly angled away from one anothertowards respective edges 6109 a, 6109 b of the tissue-facing surface6118. Such configuration can assist in engaging the one or moreattachment features 6128 with the retaining members 6122 a, 6122 b, asdiscussed below. The retaining members can be configured in any othermanner and have any other retaining features, such as, for example, oneor more teeth, notches, grooves, undercuts, roughness areas, etc., thatcan facilitate retention of the attachment features 6128 at theretaining members.

Although two retaining members 6122 a, 6122 b are shown in FIG. 45, thetissue-facing surface 6118 can have any other number of retainingmembers (e.g., one or greater than two) configured to couple an adjunctthereto. Furthermore, the retaining members can be formed at variouslocations on the tissue-facing surface 6118 of the anvil 6104. Forexample, in some embodiments, two or more retaining members can beformed along each edge 6109 a, 6109 b of the tissue-facing surface 6118.The retaining members can be formed at any suitable distance from oneanother that allows securely retaining the adjunct material on the jaw'stissue-facing surface. In addition, the retaining members can bedisposed symmetrically with respect to the knife channel 6108 or otherfeatures of the tissue-facing surface 6118, or they can be formed atvarious other ways on the surface 6118.

As shown in FIG. 45, in the example illustrated, each of the retainingmembers 6122 a, 6122 b is formed outside of the area of thetissue-facing surface 6118 having the staple-forming cavities 6116.However, in some implementations, one or more of the retaining memberscan be formed within the area having the staple-forming cavities 6116.

As mentioned above, the adjunct material 6124 is configured toreleasably couple with the anvil 6104 using at least one contractibleattachment feature 6128 configured to be transitioned from an original,non-contracted configuration to a contracted configuration underapplication of heat, as discussed in more detail below. The adjunctmaterial 6124 can couple with the anvil 6104 in a secure manner, whichhelps ensure that the adjunct 6124 remains coupled to the anvil 6104while the end effector 6100 is manipulated as desired using a surgicalprocedure. The adjunct 6124 is held in engagement with the anvil 6104until an action, such as an activation of the end effector 6100 torelease staples from its cartridge and/or an activation of a cuttingelement, is taken that causes the separation of the adjunct 6124 fromthe anvil 6104.

To accommodate a contraction of the at least one contractible attachmentfeature 6128 that occurs as a result of heating, the adjunct material6124 can be configured such that it assumes an appropriate shape andsize once heating has occurred so as to couple the adjunct material 6124to the jaw 6102. For example, the adjunct material 6124 can be sizedsuch that it extends beyond the perimeter of the tissue-facing surface6118 of the anvil 6104 prior to heating, and adopts the appropriate sizeonce heating has occurred.

The first and second retaining members 6122 a, 6122 b are configured tomate with respective mating features of the adjunct material 6124. Inparticular, in the described implementation, the adjunct material 6124includes openings 6126 a, 6126 b configured to receive the retainingmembers 6122 a, 6122 b, respectively. In this example, the throughopenings 6126 a, 6126 b in the adjunct 6124 are generally round, thoughit should be appreciated that the openings 6126 a, 6126 b can have anyother suitable shapes.

The openings 6126 a, 6126 b can have various sizes and configurations,and they can be disposed at various locations of the adjunct 6124. Forexample, the openings 6126 a, 6126 b can be formed at locations of theadjunct material 6124 that correspond to the locations of the retainingmembers 6122 a, 6122 b formed on the anvil plate 6106.

In the described implementations, as mentioned above, the retainingmembers 6122 a, 6122 b couple the adjunct 6124 to the anvil 6104 byengaging one or more contractible attachment features 6128 configured tobe transitioned from an original, non-contracted configuration to acontracted configuration under application of heat. The contractibleattachment features 6128 can be in the form of one or more strands of ashrinkable polymer, which can be coupled to the adjunct material 6124 atone or more locations. The adjunct material 6124 and the at least onecontractible attachment feature 6128 can be made from a variety ofmaterials. For example, in at least some embodiments, the adjunct 6124can be made from VICRYL® (polyglactin 910) material, whereas thecontractible attachment feature 6128 can be in the form of one or morePDO strands that can be bioabsorbable and/or biodegradable. Any othermaterials can be used additionally or alternatively. One or more of thestrands can be coupled (e.g., removably) to the adjunct material 6124.The PDO has a relatively low melting temperature, which is advantageousfor its use in conjunction with adjuncts and attachment features. Forexample, the PDO has a melting temperature of 105 C°. Heat can beapplied for, for example, from 30 seconds to several minutes to causethe attachment feature 6128 to transition into the contractedconfiguration.

Referring to FIG. 45, the contractible attachment features 6128 can beengaged with the adjunct material, and contraction of the contractibleattachment feature 6128 is effective to couple the adjunct material 6124with the retaining members 6122 a, 6122 b. For example, the adjunctmaterial 6124 can be disposed over the tissue-facing surface 6118 of thejaw 6102 such that adjunct's openings 6126 a, 6126 b receive theretaining members 6122 a, 6122 b. In some embodiments, the adjunctmaterial 6124 can be applied to the jaw using a loader member, asdiscussed below. Further, the adjunct material 6124 is associated withthe at least one contractible attachment feature 6128 which can bedisposed over the adjunct material 6124 such that the attachment feature6128 is engaged with the retaining members 6122 a, 6122 b. Theattachment feature 6128 can be coupled to the adjunct material6124—e.g., it can be in the form of one or more strands of a shrinkablepolymer, one or more of which are passed through at least one portion ofthe adjunct 6124. Heat can be applied to cause at least a portion of theattachment feature 6128 to contract to thereby cause the adjunctmaterial 6124 to couple with the retaining members 6122 a, 6122 b usingthe attachment feature 6128. In particular, the attachment feature 6128can be caused to transition from the original, non-contractedconfiguration to the contracted configuration such that, in thecontracted configuration, the attachment feature 6128 is coupled toretaining members 6122 a, 6122 b and thereby retains the adjunctmaterial 6124 in secure (albeit releasable) engagement with theretaining members 6122 a, 6122 b and thus with the anvil 6104.

It should be appreciated that the adjunct materials can be attached toan end effector using various other approaches. For example, the U.S.Pat. App. No. 614/871,078 entitled “Tubular Absorbable Constructs” filedon Sep. 30, 2015, which is incorporated by reference herein in itsentirety, describes another approach.

FIGS. 46A and 46B illustrate an embodiment of an adjunct material oradjunct 6224 that can be disposed on a tissue facing surface of a jaw(not shown), such as a jaw having an anvil (e.g., anvil 6104 in FIG.45). It should be appreciated that the jaw can also be a jaw having acartridge. In this example, the adjunct 6224 has a plurality ofattachment features 6228 associated therewith.

The attachment features 6228 can be in the form of two or moreattachment features. The attachment features 6228 can be, for example,strands of a shrinkable polymer, such as PDO strands that can passthrough at least one portion of the adjunct material, at one or morepoints. For example, the PDO strands can be woven, knitted, braded intothe adjunct 6224, or otherwise associated with the adjunct 6224. Asshown by way of example, one or more of the attachment features 6228 canbe coupled to the adjunct 6224 at points 6229 a, 6229 b, though itshould be appreciated that the attachment feature 6228 can be coupled tothe adjunct 6224 at any number of points at any locations in the adjunct6224. In some cases, the adjunct 6224 can be manufactured such that theattachment features 6228 are created during the manufacturing processand are thus part of the adjunct 6224. In other embodiments, however,some or all of the attachment features 6228 can be separate threadscoupled to the adjunct 6224.

In use, the adjunct 6224 can be mated with the jaw via retaining members6222 a, 6222 b formed on the jaw and mating with openings 6226 a, 6226 bin the adjunct 6224. As shown in FIG. 46A, before the adjunct 6224 issecurely and releasably coupled to the jaw, the attachment features 6228are in a non-contracted configuration such that they form one or moreloops that encompass both of the retaining members 6222 a, 6222 b. Asshown, the loops can be disposed in a relatively loose manner around theretaining members 6222 a, 6222 b. As discussed above, the attachmentfeatures 6228 can be associated with the adjunct in a variety of ways.For example, they can be passed through one or more portions of theadjunct 6224. Additionally or alternatively, the attachment features canbe disposed over, and coupled to the adjunct using, e.g., an adhesive.

As illustrated schematically in FIG. 46B, the adjunct 6224 can besecured to the jaw by applying heat to a region 6230 that encompasses aportion of the attachment features 6228. Under the application of heat,the attachment features 6228 transition from the non-contractedconfiguration (shown in FIG. 46A) to a contracted configuration as shownin FIG. 46B. In the contracted configuration, the attachment features6228 can be arranged such that one or more loops are engaged around theretaining members 6222 a, 6222 b and thereby releasably retain theadjunct material 6224 over the jaw. In this way, in the contractedconfiguration, the loops of the attachment features 6228 are held intension more tightly around the retaining members 6222 a, 6222 b than inthe non-contracted configuration. Also, as mentioned above, theretaining members 6222 a, 6222 b are configured to have retainingfeatures that facilitate engagement of the attachment features 6228therewith.

In the example shown in FIG. 46B, when heat is applied to a regionencompassing a portion of the attachment features 6228, the portions ofthe attachment features 6228 in that region contract. The heat can beapplied to the attachment features 6228 in a variety of ways, asdiscussed in more detail below. The contraction results in theattachment features 6228 and the through openings 6226 a, 6226 b beingtensioned around the retaining members 6222 a, 6222 b which thusreleasably retain the adjunct 6224 over the jaw. Thus, FIGS. 46A and 46Billustrate that the area of the adjunct 6224 is reduced to some degreeafter the heat has been applied. FIGS. 46A and 46B also illustrate thata shape of the openings 6226 a, 6226 b formed the adjunct 6224 changeswhen the adjunct 6224 is in the contracted configuration. In particular,the openings 6226 a, 6226 b become more stretched as the material fromwhich the adjunct 6224 is formed as pulled towards the middle of theadjunct 6224 due to the contraction of the attachment features 6228,which is also shown by arrows 6223 a, 6223 b in FIG. 46B. When thestaples are fired and a cutting element (e.g., a knife) is activated,the attachment features 6228 are cut, thus allowing the adjunct 6224 toseparate from the jaw.

It should be appreciated that the implementation in FIGS. 46A and 46B isshown by way of example only. Thus, the attachment features 6228 can bewrapped around the retaining members in many various ways. For example,as in the example illustrated, the attachment features 6228 can form oneor more loops in a substantially oval pattern. As another example, theattachment features can be arranged in a figure-eight pattern around theretaining members, or they can be arranged such that one or moreportions form one or more crisscross patterns over the adjunct. Also,the attachment feature(s) can be arranged around the retaining membersin a substantially random way. As mentioned above, one or more of theattachment features can be coupled to (e.g., woven through) the adjunctat one or more locations. Moreover, in some implementations, one or moreof the attachment features can be coupled to or interconnected with oneanother.

Furthermore, in some embodiments, the attachment features are notengaged with the retaining members. For example, the adjunct can haveopenings formed around its perimeter some or all of which can be engagedwith (e.g., receive therethrough) the retaining members of the jaw. Thecontractible attachment features, which can be coupled to the adjunct inany suitable manner (e.g., passed through the adjunct one or more times,attached used an adhesive, etc.), can be disposed in a certain way,e.g., across the middle of the adjunct, such that, when they are exposedto heat, they constrict and cause the two sides of the adjunct to bepulled together. Depending on the configuration of the adjunct and theattachment features, the adjunct will constrict or deform as a result ofthe application of heat in a suitable manner.

In the example shown in FIGS. 46A and 46B, the adjunct 6224 is securedto the tissue-facing surface of the jaw using multiple attachmentfeatures 6228. However, in some embodiments, a single continuousattachment feature can be used to secure an adjunct to a jaw of an endeffector. Such embodiments can be used, for example, if limitedinterconnection between the adjunct and the attachment feature isdesired. In other words, the attachment feature can be coupled to theadjunct in fewer locations as compared to implementations in which twoor more attachment features are used.

FIGS. 47A and 47B illustrate an embodiment in which a continuousattachment feature 6328 is used to couple an adjunct material or adjunct6324 to a jaw (not shown), such as a jaw having an anvil (e.g., anvil6104 in FIG. 45) or a jaw having a cartridge. In this example, theattachment feature 6328 is a relatively long continuous feature disposedover a portion of the adjunct 6324 as shown in FIG. 47A.

As shown, the adjunct 6324 is disposed over the jaw such that retainingmembers 6322 a, 6322 b formed on the jaw are mated with through openings6326 a, 6326 b in the adjunct 6324. As also shown, the attachmentfeature 6328 can form one or more loops that encompass the retainingmembers 6322 a, 6322 b. As shown by way of example, the attachmentfeature 6328 can be coupled to the adjunct 6324 at a point 6329, thoughit should be appreciated that the attachment feature 6328 can be coupledto the adjunct 6324 at any number of points at any locations of theadjunct 6324. The attachment feature 6328 can be woven into, knittedthrough, stitched through, or otherwise coupled to the adjunct 6324. Inaddition, in some embodiments, one or more portions of the attachmentfeature 6328 can be coupled one another, e.g., using an adhesive.Additionally or alternatively, some of the portions can be tied,twisted, bonded together, etc.

In the example illustrated, as shown in FIG. 47B, when heat is appliedto a region 6330 encompassing a portion of the attachment feature 6328,one or more portions of the attachment feature 6328 contract. As thecontraction occurs, the attachment feature 6328 is brought closertowards the retaining members 6322 a, 6322 b such that the material ofthe attachment feature 6328 engages more tightly around the retainingmembers 6322 a, 6322 b, thereby releasably retaining the adjunct 6324over the jaw. In other words, the attachment feature 6328 is held intension around the retaining members 6322 a, 6322 b. When the staplesare fired and a cutting element (e.g., a knife) is activated, theattachment feature 6328 is cut to thus allow the adjunct 6324 toseparate from the jaw.

In this way, FIGS. 46A, 46B, 47A, and 47B illustrate that the adjuncts6224, 6324 can be securely coupled to a jaw in a manner than allowsmanipulating the jaw as desired during a surgical procedure. A risk ofthe adjunct slipping off or otherwise being unintentionally andprematurely separated from the jaw is reduced or eliminated.

In the examples of FIGS. 46A, 46B, 47A, and 47B, the attachment featurescan be formed from any suitable materials. For example, they can be inthe form of one or more PDO strands. A density of the PDO strands canvary throughout the attachment features and thus throughout the adjunctto which the feature(s) are attached. In this way, the degree ofcontraction of the attachment feature(s) varies in different parts ofthe adjunct. In some cases, elongate PDO strands can be woven throughoutthe entire adjunct such that more uniform adjunct contraction can beachieved. The PDO strands can also be wrapped around the retainingmembers to ensure that they effectively engage the retaining memberswhen heat is applied and contraction occurs. As another example, theattachment features can be separate from the adjunct. In such cases,upon heating, the attachment features contract, and become secured intension between the retaining members, thereby holding the adjunct inplace, but the contraction of the attachment features may not have animpact on the configuration of the adjunct. Alternatively, as discussedabove, the attachment features can be attached to the adjunct at certainattachment points, which can be based on the desired configuration ofthe adjunct and the amount of contraction.

In the described embodiments, one or more attachment features can beused to releasably engage an adjunct with a jaw of an end effector usingheat. The heat can be applied in a variety of ways. For example, in someembodiments, heat can be applied using a loader that is configured toapply the adjunct to the jaw. FIGS. 48A and 48B illustrate an example ofa loader 6400 configured to apply an adjunct to a tissue-facing surfaceof a jaw. FIG. 48A shows a top view of the loader 6400, whereas FIG. 48Bshows a cross-sectional view of the loader 6400.

As in the illustrated example, the loader 6400 in the form of agenerally rectangular frame-like holder configured to releasably coupleone or more adjuncts to one or both jaws of the end effector (notshown). In the illustrated example, the loader 6400 is in the form of afirst (e.g., top) and second (e.g., bottom) generally rectangularhousings 6402, 6404 coupled to one another e.g., via a coupling 6406, asshown in FIG. 48B. In this example, the loader 6400 can be used to applya single adjunct to a jaw. It should be appreciated however, that, insome embodiments, a loader like the loader 6400 or a similar loader, canbe used to apply a respective adjunct to each jaw of an end effector.

The loader 6400 includes at least one heating component 6408 configuredto be activated to apply heat to attachment features, as describedbelow. The heating component 6408 can have various configurations. Forexample, as shown in FIGS. 48A and 48B, the heating component 6408includes a resistive heating element 6414 in the form of a wire. Theheating element 6414 is connected to a power source 6416. In theillustrated example, the heating element 6414 includes higher resistanceportions 6418 along its length. The locations of the higher resistanceportions 6418 can correspond to regions on an adjunct to which heat isdesired to be applied, e.g. region 6230 (FIG. 46B) or region 6330 (FIG.47B). Thus, power can be applied to the heating element 6414 to causelocalized heating near the higher resistance portions 6418. In someembodiments the heating element can include a switch 6420 that closesthe circuit and allows current to flow through the heating element. Theswitch 6420 can be operated using a suitable trigger on the loader 6400(e.g., a button), though the heating element 6414 can be activated inother suitable ways. The heat generated by the higher resistanceportions 6418 causes the attachment features that are engaged with theadjunct to contract to effectively couple the adjunct with retainingmembers of the jaw, thereby releasably retaining the adjunct over thetissue-facing surface of the jaw.

The heating component 6408 can be of any suitable type. For example, theheating component 6408 can be made of a rigid material, e.g., ceramic,that is coated with an elastic or compliant material. In someembodiments, the heating component 6408 can be in the form of aresistive wire embedded into silicone, e.g., such that the silicone iscured around the resistive wire. The resistive wire is configured toeffect the heating, whereas the silicone allows for some degree ofcompliance when clamping a stapler onto the loader. As shown in FIG.48B, the heating component 6408 can be coupled to the housings 6402,6404 via connecting features 6410, e.g., brackets.

The loader 6400 and heating component 6408 can generally be configuredsuch that an adjunct (not shown) can be placed on a surface, e.g., anupward facing surface 6412 of the heating component as shown in FIG.48B, and the jaws of the end effector can clamp over the heatingcomponent and adjunct. Although not illustrated, the loader 6400 and/orheating component 6408 can include retaining features that canreleasably secure adjuncts to surfaces 6412 and 6413 such that theadjuncts can be secured to both jaws of an end effector simultaneously.For example, the heating component 6408 can have small posts or hooksthat can grip the adjuncts to releasably secure them to surfaces 6412,6413. In one embodiment, the heating component 6408 is disposable and itis coupled to adjuncts secured to the surfaces 6412, 6413. In such anembodiment, the loader 6400 is configured to receive a heating component6408 with adjuncts attached thereto. The surgeon can load the heatingcomponent 6408 with the adjuncts into the loader 6400, and attach theadjuncts to jaws of an end effector.

Furthermore, in some embodiments, the heating component 6408 (or aheating component having another configuration) can be in the form oftwo heating components disposed in the removable loader such that eachof the heating components is configured to apply heat to a differentadjunct that can be associated therewith (e.g., via the loader ormanually). In such implementations, with reference to FIG. 48B, forexample, first and second adjuncts are placed on the surfaces 6412,6413, respectively, and heat can be applied to the adjuncts usingrespective heating components associated with the surfaces 6412, 6413.

Regardless of the specific way in which the heating component 6408 isassociated with the loader 6400, the loader 6400 can be used to bothdeliver the adjunct to the jaw (such that the adjunct is transferredfrom the loader to the jaw) and to apply heat to the adjunct. In use,the loader can be placed between the jaws of the end effector that arein an open configuration. The jaws can then be clamped over the loader6400 to thereby clamp over the heating component 6408 and the adjunctsuch that the adjunct is transferred onto the jaw and retaining memberson the jaw enter through openings on the adjunct, as illustrated, e.g.,in FIGS. 46A and 47A. At least one attachment feature can be engagedwith the adjunct, e.g., as shown for attachment features 6228, 6328 andadjuncts 6224, 6324 in FIGS. 46A and 47A, respectively. The heatingelement 6414 can be activated in a suitable manner such that heatapplied therefrom to the at least one attachment feature can cause theattachment feature to contract, which causes the adjunct material tocouple with the first and second retaining members.

In some embodiments, the act of clamping the jaws onto the heatingcomponent closes the switch 6420, thereby allowing current to flowthrough the heating element. Once the adjunct is secured to the jaw asdesired, the jaws can be opened and removed from the heating componentwhich allows the switch 6420 to open, thereby stopping the flow ofcurrent within the heating element 6414.

In other implementations, an adjunct may not be associated with aloader, such as the loader 6400, and the loader can be used only toapply heat to the adjunct (and thus to at least one attachmentfeatures). In such implementations, an adjunct is placed onto atissue-facing surface of a jaw, and attachment features engaged with ordisposed over the adjunct is looped around jaw's retaining members asdesired to loosely secure the adjunct to the end effector. The endeffector is then be clamped onto the loader with the heating component6408 of the loader 6400, and the heating element 6414 is powered,thereby causing localized heating near the high resistance portions 6418of the heating element 6414. The heat from those portions 6418 causesthe attachment features that are engaged with the adjunct to contract toeffectively couple the adjunct with the retaining members, therebyreleasably retaining the adjunct over the tissue-facing surface of thejaw.

It should be appreciated that the loader 6400 is shown by way of exampleonly. In some embodiments, a loader can use a chemical reaction tosupply heat to the attachment features. For example, the loader cangenerally be similar to loader 6400, but rather than using a heatingcomponent that includes a resistive heating element, the loader can usea heating component including one or more fluid or crystallinestructures. By way of example, the heating element can include a numberof fluid or crystalline structures that can release heat when they comein contact with each other. In some implementations clamping jaws of anend effector onto the heating component can cause internal pocketscontaining fluid or crystalline structures to crack, thereby allowingtheir internal substances to combine. When the substances combine, themixture undergoes an exothermal chemical reaction that releases heat.The heating component can be configured such that the chemical heatingelements are in the desired locations, and wherein cracking the heatingelements only breaks an internal barrier and does not cause thesubstances to spill from the heating component.

Furthermore, in some embodiments, heat can be applied to an adjunct withat least one attachment feature pre-loaded thereon using a devicedifferent from a loader. For example, the adjunct can be disposed on ajaw of an end effector and heat can be applied thereto using an infraredheater, UV heater, heat gun, or any other device configured to provideheat. In some cases, the heating can be done by placing the end effectorwith the adjunct disposed thereon in a suitable oven, heated chamber, orother enclosure configured to apply heat. The separate heating devicescan be used in embodiments in which the adjunct is pre-applied to theend effector's jaws during manufacture of the end effector. The loader,such as the loader 6400, or a similar applicator (e.g., a small heatingchamber) can be used in embodiments in which the adjunct is configuredto be applied in the operating room by the surgeon or other personduring or before a surgical procedure.

Regardless of the way in which heat is applied to the adjunct, atemperature of the heat and a duration of its application is selected soas to cause at least one attachment feature to contract and thus causethe adjunct to be attached to the jaw. For example, the heat can have atemperature of from about 6100 to about 130 degrees Celsius and it canbe applied for, for example, from about 20 seconds to about 3 minutes tocause the attachment feature to transition into the contractedconfiguration. It should be appreciated, however, that a temperature inother ranges can be applied for any suitable time period.

In some applications, an adjunct can be formed such that a plurality ofcontractible attachment features are interwoven into the adjunct along alongitudinal axis of the adjunct and along an axis that is substantiallyperpendicular to the longitudinal axis of the adjunct. FIGS. 49A and 49Billustrate an example of such an adjunct. In particular, FIGS. 49A and49B illustrate a portion of an end effector 6500 that is configured tohave an adjunct 6524 coupled to a tissue-facing 6518 surface of a jaw,wherein the adjunct 6524 has contractible attachment features 6528interwoven with the adjunct 6524 along a longitudinal axis 6A and alonga lateral axis 6B that is substantially perpendicular to thelongitudinal axis 6A.

The end effector 6500 can generally include components similar to thosedescribed with regard to end effector 6100 (FIG. 45). Thus, similar tothe end effector 6100, the end effector 6500 can include an upper jaw(not shown) having an anvil and a lower jaw having a cartridge body6504. The lower jaw includes the staple cartridge 6504 that has aplurality of staple-holding cavities 6516 configured to seat staplestherein, the staple-holding cavities 6504 opening on a tissue-facingsurface 6518 of the cartridge 6504. The staple cavities can form acertain pattern on the tissue-facing surface 6518 of the cartridge 6504which corresponds to a pattern of staple-forming cavities formed in theanvil. The cartridge 6504 includes first and second retaining members6522 a, 6522 b, located adjacent to opposed edges of the tissue-facingsurface 6518, and a knife channel 6508 extending between distal andproximal ends of the cartridge 6504.

The retaining members 6522 a, 6522 b disposed on the tissue-facingsurface 6518 of the cartridge 6504 are configured to releasably couplean adjunct material 6524 to the cartridge 6504. The first retainingmember 6522 a is disposed at one side of the tissue-facing surface 6518in proximity to one edge 6509 a of the tissue-facing surface 6518, andthe second retaining member 6522 b is disposed at another, opposed sideof the tissue-facing surface 6518 in proximity to another, opposed edge6509 b thereof. In this way, the first and second retaining members 6522a, 6522 b are disposed at opposed sides of the knife channel 6508.

The retaining members 6522 a, 6522 b can have a variety of differentconfigurations. In the example illustrated, they are in the form ofgenerally cylindrical posts extending from the tissue-facing surface6518. However, the retaining members 6522 a, 6522 b can have othershapes, as the described implementations are not limited in thisrespect. For example, the retaining members 6522 a, 6522 b can becurved, have an hour glass shape, have a bulbous or widened end region,have notches, be angled toward the edges of the tissue-facing surface,have roughness features, etc. The retaining members can be configured inany manner suitable for assisting in retaining the adjunct on the jaw.Also, although two retaining members 6522 a, 6522 b are shown in FIG.49A, the tissue-facing surface 6518 can have any other number ofretaining members (e.g., one or greater than two) configured to couplean adjunct thereto. Furthermore, the retaining members can be formed atvarious locations on the tissue-facing surface 6518 of the cartridge6504. For example, in some embodiments, two or more retaining memberscan be formed along each edge 6509 a, 6509 b of the tissue-facingsurface 6518. The retaining members can be formed at any suitabledistance from one another that allows securely retaining the adjunctmaterial on the jaw's tissue-facing surface. In addition, although inthe illustrated implementations the retaining members protrude above thesurface of the tissue-facing surface, in some embodiments, the retainingmembers can be in the form of recesses or other features disposed atleast partially below the tissue-facing surface of the jaw. This can bedone in implementations in which a reload includes reverse drivers.

As shown in FIG. 49A, in the example illustrated, each of the retainingmembers 6522 a, 6522 b is formed outside of the area of thetissue-facing surface 6518 having the staple cavities 6516. However, insome implementations, one or more of the retaining members can be formedwithin the area having the staple cavities 6516.

The adjunct material 6524 is configured to releasably couple with thecartridge 6504 using a plurality attachment features 6528 configured tobe transitioned from an original, non-contracted configuration to acontracted configuration under application of heat, as discussed in moredetail below. The adjunct material 6524 couples with the cartridge 6504in a secure manner, which helps ensure that the adjunct 6524 remainscoupled to the cartridge 6504 while the end effector 6500 is manipulatedas desired using a surgical procedure. The adjunct 6524 is held inengagement with the cartridge 6504 until an action, such as anactivation of the end effector 6500 to release staples from itscartridge and/or an activation of a cutting element, is taken thatcauses the separation of the adjunct 6524 from the cartridge 6504.

To accommodate a contraction of the at least one attachment feature 6528that occurs as a result of heating, the adjunct material 6524 can beconfigured such that it assumes an appropriate shape and size onceheating has occurred so as to couple the adjunct material 6524 to thecartridge 6504. For example, the adjunct material 6524 can be sized suchthat it extends beyond the perimeter of the tissue-facing surface 6518of the cartridge 6504 prior to heating, and adopts the appropriate sizeonce heating has occurred.

The first and second retaining members 6522 a, 6522 b are configured tomate with respective mating features of the adjunct material 6524. Inparticular, in the described implementation, the adjunct material 6524includes a plurality of through openings 6526, wherein at least firstand second openings 6526 a, 6526 b of the openings 6526 are configuredto be mated with the retaining members 6522 a, 6522 b. It should beappreciated that, depending on the number of the retaining members, morethan two of the openings 6526 can mate with respective retainingmembers.

The openings 6526 in the adjunct 6524 can have any suitable size andshape, including different sizes and shapes. In this example, theopenings 6526 are generally square, though it should be appreciated thatthe openings 6526 can have any other suitable shapes. In the illustratedexample, the attachment features 6528 can be woven through the openings6526 as shown in FIGS. 49A and 49B. Also, the openings 6526 can also bepositioned and dimensioned to control the configuration of the adjunctand internal stress imposed upon the adjunct when heat is applied andthe attachment features contract. The openings can be formed in theadjunct such that specific openings (e.g., openings 6526 a, 6526 b) areconfigured to receive corresponding retaining members. Alternatively, insome cases, when the adjunct is disposed over the jaw, the openings inthe adjunct can “find” retaining members to mate with, and it maytherefore not be necessary to make openings that specifically correspondto positions of the retaining members.

The contractible attachment features 6528 can be in the form of one ormore strands of a shrinkable polymer, which can be coupled to theadjunct material 6524 at one or more locations. The adjunct 6524 canhave any suitable number of attachment features interwoven into theadjunct 6524 such that at least one attachment feature is disposed alongthe longitudinal axis 6A and at least one attachment feature is disposedalong the lateral axis 6B. In the example of FIG. 49A, fours strands ofshrinkable polymer are disposed along the longitudinal axis 6A of theadjunct 6524 (two along each of the long sides) and two strands ofshrinkable polymer are disposed along the lateral axis 6B of the adjunct6524 (closer to the distal end of the jaw 6504). However, it should beappreciated that the attachment features 6528 can be in the form of anysuitable number of strands that can be coupled to the adjunct 6524 inany desired manner. For example, in one embodiment, one or more of thestands can be coupled to the adjunct 6524 so as to be diagonallydisposed with respect to the adjunct 6524. The strands can be coupled tothe adjunct to be able to contract in a way so as to transition one ormore portions of adjunct to a desirable shape and size. For example, thestrands must be able to cause some of the openings in the adjunct toconstrictably engage with the retaining members. In some cases, the samestrand can be interwoven into the adjunct along the longitudinal axis 6Aas well as the lateral axis 6B.

The adjunct material 6524 and the at least one contractible attachmentfeature 6528 can be made from a variety of materials. For example, in atleast some embodiments, the adjunct 6524 can be made from VICRYL®(polyglactin 910) material, whereas the contractible attachment feature6128 can be in the form of one or more PDO strands. Any other materialscan be used additionally or alternatively.

In the described implementations, the retaining members 6522 a, 6522 bcouple the adjunct 6524 to the cartridge 6504 by mating with twocorresponding openings 6526 a, 6526 b. When heat is applied, theattachment features transition from a non-contracted configuration to acontracted configuration and thereby causing the at least the openings6526 a, 6526 b to constrict around the retaining members 6522 a, 6522 b,as shown schematically in FIG. 49B. Thus, in the contractedconfiguration, the attachment features 6528 are coupled to the retainingmembers 6522 a, 6522 b or cause the adjunct 6524 to couple to theretaining members 6522 a, 6522 b. In this way, the adjunct material 6524is retained in a secure and releasable engagement with the retainingmembers 6522 a, 6522 b and thus with the cartridge 6504, as illustratedin FIG. 49B. Heat can be applied to the adjunct 6524 with the attachmentfeature 6528 using a variety of techniques, as discussed above. Forexample, loader 6400 (FIGS. 48A and 48B), or any other device configuredto provide heat can be used.

In the examples described above, an adjunct can be attached to acartridge and/or anvil during manufacturing, or by a surgeon before orduring a surgical procedure. The adjunct can be secured to the endeffector using one or more shrinkable attachment features that canchange their configuration under application of heat. In otherembodiments, however, the adjunct can be releasably coupled to the jawusing other approaches that do not require application of heat.

Thus, in some embodiments, at least one first portion of an adjunctmaterial or adjunct is configured to be reversibly stretched by anapplication of force. When the force is removed, the first portiontransitions from a stretched configuration to a contractedconfiguration, thereby causing the adjunct material to engage a jaw ofan end effector. The jaw can have one or more retaining featuresconfigured to mate with corresponding features of the adjunct. Forexample, first and second retaining features formed on the jaw can matewith mating features (e.g., openings) of the adjunct. Thus, the at leastpartially stretchable adjunct material (or portion(s) thereof) can bestretched and then allowed to contract, which causes the adjunct'smating features to engage the jaw's retaining features. In someembodiments, the adjunct can have one or more portions that aresubstantially non-stretchable.

FIG. 50 illustrates an exploded view of an example of a jaw 6602 of anend effector 6600 of a surgical instrument that has an adjunct materialreleasably secured thereto using an approach that does not depend onapplication of heat. The end effector 6600 can generally includecomponents similar to those described with regard to FIGS. 1-4, and canalso include features and/or components that enable adjuncts to bereleasably attached thereto. Thus, similar to surgical staplers 10(FIG. 1) and 50 (FIG. 4), the end effector 6600 includes an upper jawhaving an anvil and an lower jaw having a cartridge body (not shown),with only the upper jaw 6602 being shown in FIG. 50. The lower jaw cangenerally include a staple cartridge that has a plurality ofstaple-holding cavities configured to seat staples therein, thestaple-holding cavities opening on a tissue-facing surface of thecartridge.

As shown in FIG. 11, the upper jaw 6602 having an anvil 6604 has anadjunct material 6624 releasably retained on a tissue-facing surface6618 thereof, as discussed in more detail below. The anvil 6604 hasstaple-forming cavities 6616 formed on the tissue-facing surface 6618.As also shown, the tissue-facing surface 6618 has a knife channel 6608configured to receive a cutting element (e.g., a knife).

As shown in FIG. 50, the tissue-facing surface 6618 of the anvil 6604has at least first and second retaining members, e.g., retaining members6622 a, 6622 b, and can additionally include one or more retainingmembers, as illustrated by retaining member 6622 c. The retainingmembers are configured to couple the adjunct material 6624 to the anvil6604. In the example illustrated, the retaining members can engage withopenings formed in the adjunct material 6624, such as openings 6626a-6626 d, as discussed below.

As shown in FIG. 50, the retaining members 6622 a, 6622 c are disposedone side of the tissue-facing surface 6618 in proximity to one edge 6609a of the tissue-facing surface 6618, and retaining member 6622 b isdisposed at another, opposed side of the tissue-facing surface 6618 inproximity to another, opposed edge 6609 b thereof. It should beappreciated that the tissue-facing surface 6618 can have a fourthretaining member opposed to the retaining member 6622 c, which is notshown because of the partial view of the jaw 6604 in FIG. 50. Theretaining members 6622 a, 6622 b are disposed at opposed sides of theknife channel 6608.

The retaining members can have a variety of different configurations. Inthe example illustrated, they are in the form of curved posts, or hooks,that extend from the tissue-facing surface 6618 outward towardrespective the edges 6609 a, 6609 b. For example, the retaining member6622 a is curved towards the edge 6609 a, and the retaining member 6622b is curved towards the edge 6609 b. However, the retaining members canhave other shapes, as the described implementations are not limited inthis respect. For example, the retaining members can be at leastpartially straight, have an hour glass shape, have a bulbous or widenedend region, have one or more notches, be angled toward the edges of thetissue-facing surface, have roughness features, etc. The retainingmembers can be configured in any suitable manner suitable for assistingin retaining the adjunct on the jaw. Also, although three retainingmembers 6622 a, 6622 b and 6622 c are shown in FIG. 50, thetissue-facing surface 6618 can have any other number of retainingmembers (e.g., one, two, or greater than three) configured to couple anadjunct thereto. Furthermore, the retaining members can be formed atvarious locations on the tissue-facing surface 6618 of the anvil 6604.For example, in some embodiments, two or more retaining members can beformed along each edge 6609 a, 6609 b of the tissue-facing surface 6618.The retaining members can be formed at any suitable distance from oneanother that allows securely retaining the adjunct material on the jaw'stissue-facing surface. In addition, the retaining members can bedisposed symmetrically with respect to the knife channel 6608 or otherfeatures of the tissue-facing surface 6618, or they can be formed atvarious other ways on the surface 6618.

The retaining members 6622 a, 6622 b, 6622 c (and any retaining memberswhich are not shown in FIG. 50) are configured to mate with respectivemating features of the adjunct material 6624. In particular, asmentioned above, the adjunct material 6624 includes through openings6626 a, 6626 b, 6626 c configured to receive the retaining members 6622a, 6622 b, 6622 c, respectively. The fourth opening 6626 d is configuredto engage a fourth retaining member, which is not shown in FIG. 50. Thethrough openings 6626 a-6626 d in the adjunct 6624 are sized to receivetherein the respective retaining members. In this example, the openingsare generally round, though it should be appreciated that the openingscan have any other suitable shapes.

In the embodiment shown in FIG. 50, the adjunct material 6624 is atleast partially stretchable. For example, the adjunct 6624 is formedsuch that substantially its entire area is at least partiallystretchable. The adjunct 6624 can be formed from any suitable material,for example, one or more suitable absorbable polymers. In embodiments inwhich the adjunct material is made from non-brittle polymers,deformations of the adjunct can be achieved through geometric changes(e.g., by reducing the adjunct's thickness until it becomes stretchyunder a load, etc.). Additionally or alternatively, the adjunct materialcan be made at least partially stretchable by having one or more variousfeatures—for example, the adjunct can be in the form of a knitted sheetthat has elasticity due to its geometry. The adjunct can be implementedas described, for example, in U.S. patent application Ser. No.14/926,194, entitled “Extensible Buttress Assembly for SurgicalStapler,” and filed on Oct. 29, 2015, which is hereby incorporated byreference herein in its entirety.

In some embodiments, as in the example illustrated, the adjunct material6624 includes at least one second, substantially non-stretchableportion. The one or more substantially non-stretchable portions can havea variety of configurations (including different configurations amongthe portions) and they can be disposed in any suitable manner inrelation to substantially stretchable portions of the adjunct. FIG. 50illustrates that the adjunct material 6624 includes first and secondnon-stretchable portions 6628 a, 6628 b which can be associated withareas of the adjunct material 6624 that are disposed over thestaple-forming cavities 6616 when the adjunct 6624 is placed over thejaw 6602. Thus, one or more areas of the adjunct 6624 configured to bepenetrated by the staples can be reinforced by being made substantiallynon-stretchable. In the illustrated implementation, the portions 6628 a,6628 b are coupled to the adjunct material 6624 such that the portions6628 a, 6628 b are configured to be disposed between the tissue-facingsurface 6618 and the adjunct 6624, and thus seat over the tissue-facingsurface 6618.

In some embodiments, it can be beneficial to attach the non-stretchableportions 6628 a, 6628 b to the adjunct 6624 such that portions of theadjunct 6624 disposed over the staple-forming cavities 6616 areprevented from being stretched. In particular, if portions of theadjunct 6624 that are disposed over staple-cavities 6616 are stretched,then, when the adjunct 6624 is stapled to tissue and released from thejaw 6602, the adjunct 6624 can damage tissue by pulling on the staplesas it releases tension in areas where staples are formed. In this way,the non-stretchable portions can stabilize the staples and helpprotecting tissue being stapled.

The non-stretchable portions 6628 a, 6628 b can be formed in anysuitable manner. For example, the portions 6628 a, 6628 b can beseparate portions coupled to the adjunct 6624. In at least oneembodiment, the portions 6628 a, 6628 b are formed from PDO and coupledto (e.g., laminated onto), the stretchable adjunct 6624. As an example,the portions 6628 a, 6628 b can be in the form of sheet laminates thatare heat-pressed or otherwise attached onto the adjunct 6624 to createthe portions that are resistant to stretching. However, the portions6628 a, 6628 b can be coupled to the adjunct 6624 in various other ways,as the described techniques are not limited in any specific way in whichone or more portions of at least partially stretchable adjunct are madesubstantially non-stretchable. FIG. 51 shows by way of example theadjunct 6624 having a first, at least partially stretchable portion6623. As also schematically shown in FIG. 51, first and second areas6629 a, 6629 b of the portion 6623 of the adjunct 6624 (which is, inthis example, the entire adjunct) are configured to have portions 6628a, 6628 b in the form of sheet laminates coupled thereto.

It should be appreciated that the two separate non-stretchable portions6628 a, 6628 b are shown in FIG. 50 by way of example only. In someembodiments, one or more than two substantially non-stretchable portionscan be associated with the adjunct material, and such portions can bedisposed in various ways with respect to the stretchable portion(s) ofthe adjunct.

Furthermore, in at least one embodiment, the second portion can be inthe form of a substantially non-stretchable second adjunct material thatis coupled to the adjunct material and has any suitable size (e.g., itcan have a smaller area than the “first” stretchable adjunct material).The second adjunct material is configured to reinforce and/or treat atreatment site in a patient, whereas the first stretchable adjunctmaterial is configured to engage the first and second adjunct materialswith the retaining members formed on the jaw. In some embodiments, thesecond adjunct can include drugs or other treating agents intended to bedelivered to the treatment site. The non-stretchable portion(s) in theform of the second adjunct material can be coupled to the first adjunctmaterial such that the second adjunct material is disposed on thetissue-facing surface of the jaw, similar to the non-stretchableportions 6628 a, 6628 b in FIG. 50. However, in some implementations,the second adjunct material can be disposed over the first adjunctmaterial such that the stretchable adjunct material is disposed directlyon the jaw.

It should further be appreciated that at least one substantiallynon-stretchable portion of the adjunct can be formed in other variousways. For example, the non-stretchable portion(s) can be part of theadjunct material. In particular, it can be in the form of at least onesecond portion having at least one property that is different from atleast one property of other portions of the adjunct material. As anexample, one or more portions of the adjunct (e.g., portions to bedisposed over staple-forming or staple-holding cavities) can be moretightly woven, knitted, braded, or otherwise made non-stretchable orless stretchable than the remainder of the adjunct.

In use, the adjunct material 6624 is configured to be releasably coupledwith the anvil 6604 by reversibly stretching at least a first portion ofthe adjunct (e.g., the at least partially stretchable portion) using anapplication of force such that, when the force is removed, the firstportion transitions from a stretched configuration to a contractedconfiguration, thereby causing the adjunct material to be engaged withthe retaining members. The adjunct material 6624 couples with the anvil6604 in a secure manner, which helps ensure that the adjunct 6624remains coupled to the anvil 6604 while the end effector 6100 ismanipulated as desired using a surgical procedure. The adjunct 6624 isheld in engagement with the anvil 6604 until an action, such as anactivation of the end effector 6600 to release staples from itscartridge and/or an activation of a cutting element, is taken thatcauses the separation of the adjunct 6624 from the anvil 6604.

FIGS. 52A and 52B illustrate an example of a method of coupling theadjunct material 6624 with the jaw 6602. FIG. 52A shows the jaw 6602 andthe adjunct 6624 prior to the adjunct 6624 being coupled to the jaw6602. As shown schematically in FIG. 52A, the adjunct 6624 is beingstretched such that the openings 6626 a, 6626 b in the adjunct 6624extend beyond the retaining members 6622 a, 6622 b formed on the jaw6602.

The adjunct material 6624 has at least one portion configured to bereversibly stretched using application of a force. FIG. 52A shows across-section view of the upper jaw 6602 wherein the adjunct 6624 isstretched prior to being coupled to the upper jaw 6602, adjacent thetissue-facing surface 6618. As illustrated by the double-ended arrow,the adjunct 6624 is stretched laterally across the tissue-facing surface6608 of the upper jaw 6602. In this example, non-stretchable portions6628 a, 6628 b are attached to the adjunct 6624 between the adjunct 6624and the tissue-facing surface 6618 of the upper jaw 6602 such that theareas of the adjunct 6624 having the portions 6628 a, 6628 b coupledthereto substantially do not stretch. In FIG. 52A, the portions of theadjunct 6624 that do not have the portions 6628 a, 6628 b coupledthereto, e.g., portion 6625 and other remaining adjunct's portions, areshown stretched such that the openings 6626 a, 6626 b extend beyond theretaining members 6622 a, 6622 b.

The at least one portion of the adjunct material 6624, such as theportion 6625, can be stretched using application of a force, asdiscussed in more detail below. When the force is removed, the stretchedportion transitions from a stretched configuration to a contractedconfiguration, which causes the adjunct material 6624 to be engaged withthe first and second retaining members 6622 a, 6622 b. Thus, FIG. 52Bshows the upper jaw 6602 with the adjunct coupled to the tissue-facingsurface 6618 thereof via the retaining members 6622 a, 6622 b. Inparticular, the retaining members 6622 a, 6622 b are received inopenings 6626 a, 6626 b such that the adjunct is retained on the jaw.The adjunct material 6624 is thus held in tension by the retainingmembers 6626 a, 6626 b engaged with the openings 6626 a, 6626 b suchthat a possibility of the adjunct material 6624 prematurely slipping offthe jaw is decreased or eliminated. During a surgical procedure, afterthe jaw 6602 with the adjunct material 6624 coupled thereto ismanipulated and positioned as desired, the firing of staples and/or acutting element releases the tension such that the adjunct material 6624slips off the retaining members 6626 a, 6626 b and becomes separatedfrom the jaw 6602.

At least partially stretchable adjunct can be attached to one or bothjaws of an end effector in a number of various ways. For example, insome embodiments, one or more adjuncts can be attached to jaws of an endeffector using a removable loader member configured to releasably retainan adjunct material thereon until the adjunct material is applied to atleast one jaw. FIGS. 53A-53C illustrate an example of an end effector6700 that can be used with a member or loader 6700, to attach one ormore adjunct materials or adjuncts to the end effector 6800.

The end effector 6700 can generally include components similar to thosedescribed with regard to end effector 6600, and can also includefeatures and/or components that facilitate attaching one or moreadjuncts thereto using a loader, e.g., loader 6800, to attach adjuncts.Thus, the end effector 6700 includes a first (upper in FIGS. 53A-53C)jaw 6702 having an anvil 6704 and a second (lower in FIGS. 53A-53C) jaw6752 having a cartridge body. In this example, the loader 6800 isconfigured to apply first and second adjuncts 6724, 6774 to the firstand second jaws 6702, 6752, respectively.

FIG. 53A shows a cross-sectional view of the end effector 6700, whereinthe jaws 6702, 6752 of the end effector 6700 are disposed over theloader 6800 prior to the adjuncts 6724, 6774 being coupled to the jaws6702, 6752. As shown in FIG. 53A, in this example, the anvil 6704includes a multi-level (e.g., a two-plane or two-level) tissue-facingsurface formed of surfaces 6718, 6719, wherein the surface 6718 extendsin a plane closer to the cartridge 6752 and the surfaces 6719 arestepped out surfaces disposed in a plane that is further away from thecartridge 6752. At least portions of the tissue-facing surfaces 6718,6719, have staple-forming cavities 6716 formed thereon. However, in someembodiments, the stepped surfaces 6719 may not have staple-formingcavities. The tissue-facing surface 6718 has a knife channel 6708configured to receive a cutting element (e.g., a knife). It should beappreciated that the anvil 6704 is shown to have the two-leveltissue-facing surface by way of example only, as the anvil 6704 can havea tissue-facing surface formed in substantially one planes, or, in someimplementations, in more than two planes.

As shown in FIG. 53A, the tissue-facing surfaces 6719 of the anvil 6704have at least first and second retaining members 6722 a, 6722 b formedthereon. The tissue-facing surfaces 6719 can additionally include otherretaining members, similar to those discussed above with regard to endeffector 6600. For example, each of distal and proximal ends of thetissue-facing surfaces 6719 can have two retaining members. However,other number and positions of the retaining members can be implementedadditionally or alternatively. The retaining members are configured tocouple the adjunct material 6724 to the anvil 6704. In the exampleillustrated, the retaining members can engage with openings formed inthe adjunct material, as discussed below.

The cartridge 6752 has a plurality of staple-holding cavities 6766configured to seat staples therein, the staple-holding cavities 6766opening on tissue-facing surface 6768 of the cartridge 6752. The staplecavities can form a certain pattern on the tissue-facing surfaces 6768,which corresponds to a pattern of the staple-forming cavities 6716formed in the anvil 6704. The cartridge includes first and secondretaining members 6772 a, 6772 b, located on angled surfaces 6769 thatare adjacent to the tissue-facing surface 6768. The retaining members6772 a, 6772 b disposed on the angled surfaces 6769 are configured toreleasably couple the adjunct material 6774 to the cartridge jaw 6752.As also shown, the tissue-facing surface 6768 has a knife channel 6758configured to receive a cutting element (e.g., a knife). It should beappreciated that the cartridge 6752 is shown to have the angled surfaces6769 by way of example only, as the cartridge 6752 may not have suchsurfaces in other implementations, or it may have other suitableconfigurations.

The loader 6800 can have any suitable configuration. In the exampleillustrated, the loader 6800 can be in the form of a generallyrectangular frame-like holder configured to releasably couple one ormore adjuncts to one or both jaws of the end effector. As shown in FIGS.53A-53C, the loader 6800 can be in the form of a first (e.g., top) andsecond (e.g., bottom) generally rectangular housings 6802 and 6804coupled to one another along interface A. Jaw-facing surfaces 6806,6808, of the loader 6800 can have compressible (e.g., elastic, orpliable), members or bodies 6810, 6812, attached thereon. Thecompressible bodies 6810, 6812 can be made of, e.g., silicone, or anyother compressible and at least partially resilient material suitablefor being compressed. The elastic members 6810, 6812 can includegripping members 6814 a, 6814 b, 6816 a, 6816 b, that extend fromjaw-facing surfaces 6818, 6820, respectively.

As illustrated in FIG. 53A, the adjuncts 6724, 6774, can be coupled tothe elastic members 6810, 6812 of the loader 6800, which can be doneduring assembly of the loader 6800, or at any other time. The adjuncts6724, 6774 can be substantially similar to adjunct 6624 (FIGS. 52A and52B), and they can include openings, which can be mated with grippingmembers 6814 a, 6814 b, and 6816 a, 6816 b, to releasably secure theadjuncts to the elastic members 6810, 6812. Similar to the adjunct 6624,adjuncts 6724, 6774 each include first and second non-stretchableportions 6728 a, 6728 b, 6778 a, 6778 b.

To apply the adjuncts 6724, 6774 to the jaws 6702, 6752, the jaws 6702,6752 can be clamped over the loader 6800 having the elastic members6810, 6812 coupled to the adjuncts 6724, 6774, as illustrated in FIG.53B. The clamping action causes the jaws 6702, 6752 to apply a force tothe elastic members 6810, 6812 which, as a result, compress and stretchlaterally, thereby causing the adjunct to also stretch, as shown in FIG.53B. As also shown, the elastic members 6810, 6812 are configured tomove from their original, non-compressed configuration to a compressedconfiguration such that they stretch in a substantially uniform manner,such that one or more portions of the adjuncts 6724, 6774 can also bestretched in a substantially evenly manner. In the illustrated example,the tissue-facing surfaces 6718, 6768 are configured to engage theadjunct prior to the retaining members 6722 a, 6722 b, 6772 a, 6772 b,which can allow the adjunct to expand without getting caught on theretaining members 6722 a, 6722 b, 6772 a, 6772 b.

When the jaws 6702, 6752 are opened and the clamping force applied bythe jaws 6702, 6752 is removed, as shown in FIG. 53C, the adjuncts 6724,6774 are released from the engagement with the elastic members 6810,6812, which at least partially return to their original, non-compressedconfiguration, as also shown. This causes the adjuncts 6724, 6774 to atleast partially contract. When sufficient contraction has occurred, theadjuncts 6724, 6774 are separated from the loader 6800. For example, theopenings in the adjuncts 6724, 6774 can mate with the retaining members6722 a, 6722 b, 6772 a, 6772 b that thus displace the gripping members6814 a, 6814 b, 6816 a, 6816 b previously engaged with the openings.Additionally or alternatively, in some embodiments, the retainingmembers 6722 a, 6722 b, 6772 a, 6772 b formed on the jaws 6702, 6752 canengage portions of the adjuncts 6724, 6774 other than the openings. Forexample, one or more portions of the adjuncts can be stretched (as shownin FIG. 53B), then at least partially contracted and engaged with theretaining members 6722 a, 6722 b, 6772 a, 6772 b.

Regardless of the specific way in which the retaining members 6722 a,6722 b, 6772 a, 6772 b can mate with the adjuncts 6724, 6774, theadjuncts 6724, 6754 are released from the gripping members 6814 a, 6814b and become coupled to the jaws 6702, 6752, as illustrated in FIG. 53C.The adjuncts 6724, 6754 can be held over the jaws 6702, 6752 in at leastpartially stretched configuration. In this example, the substantiallynon-stretchable portions 6728 a, 6728 b, 6778 a, 6778 b of the adjuncts6724, 6754 can be disposed over the jaws so as to be penetrated by thestaples when the staples are ejected. The loader 6800 can then beremoved. In use, after the end effector 6700 is manipulated as desiredduring a surgical procedure, the firing of the staples and/or a cuttingelement causes the adjuncts 6724, 6754 to separate from the jaws.

It should be appreciated that, although in FIGS. 53A-53C the loader 6800is configured to deliver the adjuncts 6724, 6774 to both of the jaws6702, 6752, in some embodiments the loader 6800 can be used to apply oneof the adjuncts to one of the jaws. It should also be appreciated thatthe loader 6800 is shown by way of example only, as at least partiallystretchable adjunct can be applied to one or both jaws of an endeffector using a loader having any other suitable configuration.

In the embodiments described above, an adjunct material can bereleasably coupled to a jaw of an end effector during manufacturing ofthe end effector or during a surgical procedure. Furthermore, theembodiments can have different variations. For example, a jaw of an endeffector having a cartridge can seat a removable and replaceablecartridge, or the entire jaw with a cartridge can be removable andreplaceable. A jaw can also be part of a disposable loading unitconfigured to be coupled distally to a shaft of a surgical instrument.As another example, although the systems and methods for releasablyretaining an adjunct material over a jaw of an end effector aredescribed in connection with linear staplers of various configurations,it should be appreciated that the described techniques can beimplemented in connection with circular surgical staplers, e.g.,circular surgical stapler 80 as illustrated in FIG. 5.

Suction Attachment of an Adjunct to a Surgical Instrument

In general, when using an adjunct in conjunction with a surgicalstapler, the adjunct can be removably attached to the end effector. Theadjunct will preferably remain secured to the end effector while the endeffector is positioned at a treatment site, and is removed from the endeffector when staples are deployed at the treatment site to provide thebenefits discussed above. However, it has been observed that adjunctscan prematurely detach from the end effector prior to staple deployment.Detachment of the adjunct from the end effector can occur in variousforms, depending on the manner in which the end effector is used. Forexample, detachment can include vertical lift off of the adjunct fromthe end effector, lateral sliding of the adjunct with respect to the endeffector, and/or curling of the edges of the adjunct from the surface ofthe end effector. The adjunct can also slide sideways when an endeffector is used to clamp and twist tissue.

FIGS. 54-58 illustrate various exemplary devices and methods forattaching an adjunct to a surgical instrument. In general, an adjunctcan include a plurality of suction members configured to attach theadjunct to an end effector jaw of surgical instrument by a suctionforce/partial vacuum, which in certain aspects can be generated when theadjunct is compressed against the end effector jaw. The suction memberscan be further configured to release the suction/partial vacuum,decoupling the adjunct from the end effector jaw at a treatment site.Embodiments of the adjuncts are discussed below in conjunction with thestapler 10, where the suction members couple the adjunct to a tissuecontacting surface 33 of the upper jaw 34 of an end effector 30.However, a person skilled in the art will appreciate that embodiments ofthe suction members can be employed with any surgical instrument withoutlimit. Furthermore, embodiments of the suction members can be employedto couple adjuncts with the tissue contacting surface 33 of the upperjaw 34, a tissue contacting surface of the lower jaw 32, andcombinations thereof.

FIGS. 54-55C illustrate an embodiment of an adjunct 7500 that includes aplurality of suction members 7502 disposed upon the tissue contactingsurface 33 (e.g., an anvil surface) of the upper jaw 34 of staplingdevice 10. As described in detail below, each of the suction members7502 can be formed within the adjunct 7500 and can be configured tocouple the adjunct 7500 to the upper jaw 34. For example, the suctionmembers 7502 can provide a suction force/partial vacuum between theadjunct 7500 and the tissue contacting surface 33 that is sufficient toinhibit lateral sliding and vertical removal of the adjunct 7500 withrespect to the tissue contacting surface 33 prior to placement at atreatment site.

In the embodiment shown in FIGS. 54-55C, the adjunct 7500 can be formedas a flexible laminate, including a first adjunct layer 7500 a and asecond adjunct layer 7500 b. The first and second adjunct layers 7500 a,7500 b can be coupled together along a common interface. In an exemplaryembodiment, the first adjunct layer 7500 a includes the plurality ofsuction members 7502 and the second adjunct layer 7500 b issubstantially solid, non-permeable, and void-free. The plurality ofsuction members 7502 include a plurality of air pockets or voids 7504formed beneath the surface of the first adjunct layer 7500 a andrespective openings 7506 formed in an outer surface of the first adjunctlayer 7500 a. While the first and second adjunct layers 7500 a, 7500 bare illustrated as single layers, a person skilled in the art willappreciate that either or both of the first and second adjunct layerscan be formed from two or more discrete layers fused together.

The plurality of suction members 7502 can be formed in a variety ofways. In one embodiment, the voids 7504 can be formed by cutting pocketshaving a selected shape through an inner surface and into a bulk of thefirst adjunct layer 7500 a, separated from the outer surface by aselected distance. In another embodiment, the first adjunct layer can becast from a melt using a mold that defines the pockets and, optionally,the openings 7506 therein. In either scenario, respective openings 7506can be further formed through each of the pockets to the outer surfaceof the first adjunct 7500 a. A diameter of each opening 7506 can be lessthan its corresponding pocket. Once the pockets and openings 7506 areformed, the first adjunct layer 7500 a can be placed on the secondadjunct layer 7500 b and coupled thereto to close the pockets on allsides except for the openings 7506, forming the voids 7504. For example,the first and second adjunct layers 7500 a, 7500 b can be fused togetheralong a common interface including the inner surface of the firstadjunct layer 7500 a by one or more of application of heat, adhesives,activation of the first and/or second adjunct layers 7500 a, 7500 b by asolvent, and any other mechanism for lamination of the first and secondadjunct layers 7500 a, 7500 b. A person skilled in the art willappreciate that, while FIGS. 54 and 55A-55C illustrate the plurality ofvoids 7504 as having rectilinear shapes, they can adopt any desiredshape.

A suction force/partial vacuum can be generated between the suctionmembers 7502 and the tissue contacting surface 33 as follows. Asillustrated in FIG. 55A, the adjunct 7500 can be oriented with the outersurface of the first adjunct layer 7500 a opposite the tissue contactingsurface 33 of the upper jaw 34. Subsequently, the adjunct 7500 can bepositioned on the upper jaw 34, with the first adjunct layer 7500 acontacting the tissue contacting surface 33, and the second adjunctlayer 7500 b can be compressed against the tissue contacting surface 33,as illustrated in FIG. 55B. This compression can establish a partialvacuum within the plurality of voids 7504 by elastically deforming theplurality of voids 7504 and expelling air from the plurality of voids7504 to the environment via the plurality of openings 7506. Since thepressure of the surrounding atmosphere is greater than the pressurewithin the plurality of voids 7504, the atmosphere presses the pluralityof voids 7504 against the tissue contacting surface 33, establishing thesuction force/partial vacuum that secures the adjunct 7500 to the upperjaw 34. A person skilled in the art will appreciate that, while theadjunct 7500 is illustrated as a laminate in FIGS. 54-55C, alternativeembodiments of the adjunct can be formed as a single layer that includesthe plurality of suction members 7502.

The adjunct 7500 can be formed from one or more materials configured toallow flexure of the adjunct 7500 and deformation (e.g., elasticdeformation) of the adjunct 7500 under compression. For example, thefirst and second adjunct layers 7500 a, 7500 b can each be independentlyselected from materials possessing a stiffness that provides a desireddegree of elastic deformation under flexure and/or compression. Examplesof suitable materials can include, but are not limited to, syntheticmaterials and biologic materials. Synthetic materials can includebiodegradable polymers such as polydioxanone (PDS), Monocryl®(poliglecaprone 25, a copolymer of glycolide and ε-caprolactone;Ethicon, Inc.), polyhydroxy acids (e.g., poly-lactides, polyglycolides,polyhydroxybutyrates, polyhydroxy-valeriates), copolymers of lactide andtrimethylene carbonate, copolymers of glycolide, lactide andtrimethylene carbonate, polycaprolactones, polydioxanones, synthetic ornatural oligo- and polyamino acids, polyphosphazenes, polyanhydrides,polyorthoesters, polyphosphates, polyphosphonates, polyalcohols,polysaccharides, and polyethers. Biologic materials can include, but arenot limited to, naturally-occurring materials (e.g., collagens,gelatin), naturally-derived materials (e.g., bioabsorbable gel filmscross-linked with omega-3 fatty acids), and oxygenized regeneratedcellulose (ORC). In certain embodiments, a thickness of each of thefirst and second adjunct layers 7500 a, 7500 b can be independentlyselected from the range of about 8 μm to about 25 μm. The arrangement ofthe suction members 7502 within the adjunct 7500 can be configured tofacilitate deformation of the adjunct 7500 under compression. Forexample, as further illustrated in FIG. 55B, at least a portion of thesuction members 7502 can be formed in a pattern that substantiallymatches a pattern of staple-receiving cavities 7043 formed in the tissuecontacting surface and aligned with the staple-receiving cavities 7043when positioned on the upper jaw 34. The suction members 7502 aligned inthis manner can be more easily compressed against the upper jaw 34, ascompared to suction members 7502 that are not aligned because they arenot supported by the upper jaw 34 (e.g., the tissue contacting surface33 is recessed from the first adjunct layer 7500 a by thestaple-receiving cavities 7043). One skilled in the art will appreciatealternative embodiments of the suction members 7502 can alternatively oradditionally be patterned for alignment with the pockets 41 of thetissue contacting surface of the lower jaw 32.

The adjunct 7500 can also be applied to the tissue contacting surface 33using an applicator (not shown) that facilitates compression of theadjunct 7500. The applicator can include raised areas having a similarshape and/or distribution pattern as the staple-receiving cavities 7043.When a raised area of the applicator is aligned with a given suctionmember 7502 and staple-receiving cavity 7043, the raised area can extendwithin the staple-receiving cavity 7043 and compress the suction member7502 by a greater degree than a planar applicator. One skilled in theart will appreciate alternative embodiments of the applicator can bepatterned for alignment with the pockets 41 of the tissue contactingsurface of the lower jaw 32.

The suction members 7502 can also be configured in a variety of ways toadjust the suction force/partial vacuum. In one example, the suctionforce/partial vacuum of a given suction member 7502 can be raised orlowered by increasing or decreasing the volume of the plurality of voids7504, assuming a constant pressure difference between the atmosphere andthe plurality of voids 7504. In another example, the total suction forceexerted on the adjunct 7500 by the plurality of suction members 7502 canbe raised or lowered by increasing or decreasing the number of suctionmembers 7502 within the adjunct 7500, assuming each suction member 7502is the same volume. Furthermore, by varying the location of suctionmembers 7502 within the adjunct 7500, the suction force/partial vacuumcan be locally increased or decreased at selected areas of the adjunct7500.

The suction members 7502 can be further configured to release theadjunct 7500 from the tissue contacting surface 33 after penetration ofstaples through the adjunct 7500, allowing the adjunct 7500 to beretained at a tissue treatment site when the end effector 30 isretracted from the tissue. In one embodiment, the suction force/partialvacuum exerted by the plurality of suction members 7502 can be tailored,as discussed above, so that the force with which the adjunct 7500 isattached to the tissue by the staples is greater than the suction force.Thus, after the staples are deployed through the adjunct 7500 and thetissue, the adjunct 7500 can be released from the tissue contactingsurface 33. In another embodiment, illustrated in FIGS. 55B-55C, atleast a portion of the suction members 7502 can be aligned withrespective staple-receiving cavities 7043. In an exemplary embodiment(FIG. 55C), staples 7510 fired through the adjunct 7500 and into thestaple-receiving cavities 7043 can pierce the plurality of voids 7504 tobreak the suction/partial vacuum.

Embodiments of the adjunct 7500 can optionally include one or morefeatures configured to work in combination with suction members 7502 toinhibit sliding of the adjunct 7500 when positioned on the tissuecontacting surface 33. For example, the adjunct 7500 can include one ormore protruding features (not shown) that extend outward from thesurface of the first adjunct layer 7500 a. These features can bedimensioned for receipt within one or more recessed areas formed withinthe tissue contacting surface 33. As shown in FIG. 54, one embodiment ofthe recessed areas can include a slot 7044 formed in the upper jaw 34that is configured to receive the knife blade 36 or other cuttingelement during advancement between the jaws 32, 34. When the adjunct7500 is positioned on the tissue contacting surface 33 one or moreprotruding features can extend within the slot 7044 and maintain thelateral position of the adjunct 7500 when experiencing shear stresses.The suction members 7502 can be distanced from the location of theprotruding features to avoid interference with compression of thesuction members 7502.

Another embodiment of an adjunct 7700 is illustrated in FIGS. 56A-57C.The adjunct can generally be configured and used similar to the adjunct7500, attaching to the tissue contacting surface 33 via suctionforce/partial vacuum and releasing from the tissue contacting surface 33when staples are deployed. As shown in FIGS. 56A-56B, the adjunct 7700includes coupled first and second adjunct layers 7700 a, 7700 b and aplurality of suction members 7702. In this implementation, the suctionmembers 7702 can be formed as hollow protrusions extending outward froma surface of the first adjunct layer 7700 a, opposite the second adjunctlayer 7700 b. The protrusions can define a plurality of air pockets 7704in fluid communication with respective openings 7706 extending througheach protrusion. While the first and second adjunct layers 7700 a, 7700b are illustrated as single layers, a person skilled in the art willappreciate that either or both of the first and second adjunct layerscan be formed from two or more discrete layers fused together.

As shown in FIGS. 57A-57C, the adjunct 7700 can be positioned on thetissue contacting surface (FIG. 57A) and suction members 7702 can becompressed to expel air from the air pockets 7704 to the environment viathe openings 7706, forming a suction force/partial vacuum therein (FIG.57B). The air pockets 7704 can further release the suction resultingfrom the partial vacuum when the staples are fired through the adjunct7700. In an exemplary embodiment, the suction force/partial vacuum canbe released by piercing the air pockets 7704 with staples 7710, as shownin FIG. 57C. Alternatively or additionally, the force of thesuction/partial vacuum provided by the plurality of suction members 7702can be overcome by the strength of attachment of the staples 7710 totissue (not shown) when the end effector 30 is removed from the tissue.A person skilled in the art will appreciate that, while FIGS. 56A-57Cillustrate the plurality of suction members 7702 as having generallycircular shapes, the suction members 7702 can adopt any desired shape.For example, FIG. 58 illustrates an embodiment of an adjunct 7900 thatincludes a plurality of suction members 7902 with air pockets 7904formed therein and having openings 7906. As shown, the suction members7902 have a shape that conforms to the shape of the staple-receivingcavities 7043.

The plurality of suction members 7702, 7902 can be formed in a varietyof ways. In one embodiment, protrusions can be formed by casting thefirst adjunct layer 7700 a from a melt using a mold that defines voidshaving a selected shape therein. Subsequently, respective openings 7706,7906 can be formed through each of the voids to the outer surface of thefirst adjunct 7700 a. A diameter of each opening 7706, 7906 can be lessthan a width of its corresponding void. After the voids and openings7706, 7906 are formed, the first adjunct layer 7700 a can be placed onthe second adjunct layer 7700 b and coupled thereto to close the voidson all sides except for the openings 7706, 7906, forming the air pockets7704, 7904. For example, the first and second adjunct layers 7700 a,7700 b can be fused together along a common interface including theinner surface of the first adjunct layer 7700 a by one or more ofapplication of heat, adhesives, activation of the first and/or secondadjunct layers 7500 a, 7500 b by a solvent, and any other mechanism forlamination of the first and second adjunct layers 7700 a, 7700 b.

The plurality of suction members 7702, 7902 can also be configured toinhibit lateral sliding of the adjuncts 7700, 7900 when positioned onthe upper jaw 34. In one embodiment, at least a portion of the suctionmembers 7702, 7902 can possess a shape dimensioned for receipt withinthe plurality of staple-receiving cavities 7043. For example, the shapeof the suction members 7902 can be configured to mate with the pluralityof staple-receiving cavities 7043. In these implementations, when thesuction members 7702, 7902 are received within the staple-receivingcavities 7043 and the adjunct 7700 is subjected to in-plane forces(e.g., shear forces), the lateral sides of the staple-receiving cavities7043 can constrain the lateral motion of the suction members 7702, 7902,thereby inhibiting lateral motion of the adjuncts 7700, 7900.

In an embodiment, any of the adjuncts 7500, 7700, 7900 can also beconfigured to perform a healing function when positioned on tissue. Suchhealing functions can include, but are not limited to, delivering amedicant, reinforcing tissue, promoting tissue ingrowth or adhesions,deter adhesions, and the like.

Adjunct Material with Mating Features

In some implementations, an adjunct or adjunct material can beconfigured to be releasably retained on a jaw of an end effector for asurgical instrument using different types of features. Specifically, anadjunct material is provided that includes features for releasablyattaching the adjunct material to the end effector and features forpreventing stretching and/or displacement of the adjunct material as itis transferred to a treatment site in a patient.

The features for attaching the adjunct material to the end effector canbe referred to as “retaining” features that are formed on the adjunctsuch that it can mate with respective features formed on the jaw (ananvil or a cartridge), to releasably retain the adjunct on the jaw. Theadjunct is releasably retained on the jaw such that the adjunct remainsattached to the jaw until the adjunct is applied to a treatment site.The adjunct additionally includes features that can be referred to as“non-retaining” features that are configured to mate with respectivefeatures on the jaw on which the adjunct is mounted such that theadjunct is able to move at least in a plane parallel to thetissue-facing surface. Such “non-retaining” features allow avoidingstretching, sliding off, and/or displacement of the adjunct materialfrom its proper position at a treatment site to which the adjunctmaterial is delivered when the staples are deployed. The adjunct isconfigured to be positioned on a jaw such that it is aligned with thestaple pattern such that the staples, when ejected, penetrate theadjunct at desired locations.

When an end effector is deployed and tissue is clamped between the jawssuch that the jaws apply force thereto, squeeze the tissue, and cause itto be penetrated by the deployed staples, the tissue is deformed. Forexample, portions of the tissue may flow out under the load and can formenlarged areas, which can cause the adjunct to be stretched anddisplaced from its intended position at the treatment site. Thismisalignment and displacement of the adjunct can negatively affect theproper reinforcement and/or treatment of the tissue at the surgical sitewith the adjunct material. Accordingly, the described techniques providean adjunct material that includes features that prevent the undesirablestretching and/or displacement of the adjunct material. Such features ofthe adjunct can mate with complementary features formed on a jaw of anend effector on which the adjunct material is mounted.

In general, in the described implementations, a jaw of the end effectorincludes a plurality of male features formed on a tissue-facing surfaceof the jaw. The adjunct material can have a plurality of femalefeatures, with each female feature being able to encompass acorresponding one of the male features in a clearance fit such that theadjunct material is able to move with respect to the jaw on which it ismounted at least in a first plane parallel to the tissue-facing surfaceof the jaw. In this way, these “non-retaining” female and male featureslimit movement of the adjunct laterally and longitudinally (i.e. in thex and y directions), while not limiting movement of the adjunct in avertical direction (i.e. in the z direction), which causes the adjunctto remain properly positioned during staple deployment at a treatmentsite.

The adjunct material also has at least one attachment feature configuredto releasably retain the adjunct material on the at least one jaw. Such“retaining” features releasably retain the adjunct with respect to atissue-facing surface of the jaw until the adjunct is caused to betransferred to the treatment site. Thus, the retaining features can beused to retain the adjunct on the jaw in a substantially non-movablemanner. As the staples are deployed by being ejected from an endeffector's cartridge, the staples cause the adjunct material to beseparated from the jaw to become attached to the tissue with thestaples.

FIG. 59 illustrates an example of a portion of the end effector 8100having first and second opposed jaws configured to clamp tissuetherebetween, in accordance with the described techniques. The endeffector 8100 can be used with any suitable surgical instrument, forexample, a linear surgical stapler (e.g., stapler 10 in FIG. 1, stapler50 in FIG. 4, or any other surgical stapler) which can be suitable foruse with at least one adjunct. The end effector 8100, only a portion ofwhich (an upper jaw or anvil 8102) is shown in FIG. 59, can be coupledto a distal end of a shaft of the surgical stapler (not shown). As shownin FIG. 59, the anvil 8102 has a plurality of staple-forming pockets orcavities 8104 formed on a tissue-facing surface 8106 of the anvil 8102.The staple-forming cavities 8104 form a certain pattern on the surfaceof the anvil 8102 which corresponds to a pattern of staple-holdingcavities in the cartridge of the end effector 8100 (not shown in FIG.59). The anvil 8102 includes an anvil knife channel 8108 extendingbetween distal and proximal ends 8102 d, 8102 p of the anvil 8102. Theanvil knife channel 8108 is configured to receive a cutting element(e.g., a knife) as the cutting element moves distally through acartridge knife slot in the staple cartridge.

The end effector 8100 includes an adjunct material 8105 mounted thereon,a portion of which is shown in FIG. 59 for illustration purposes only.In the example illustrated, the generally rectangular adjunct material8105 includes both retaining and non-retaining features for mating withthe anvil of the end effector, as discussed below. It should beappreciated that the anvil 8102 is shown by way of example, as theadjunct material can also be mounted on a cartridge using the describedtechniques. Further, in some embodiments, both anvil and cartridge of anend effector have respective adjunct materials releasably mated theretousing both retaining and non-retaining features in accordance with thedescribed techniques.

As shown in FIG. 59, the anvil 8102 includes non-retaining features inthe form of male features, such as, in this example, four posts orprojections 8110 a, 8110 b, 8110 c, 8110 d formed on the tissue-facingsurface 8106 of the anvil 8102. As also shown in FIG. 59, the adjunctmaterial 8105 also has non-retaining features such as female features inthe form of openings configured to encompass corresponding male featuresin a clearance fit. Because the adjunct material 8105 is shown onlypartially in FIG. 59, two openings 8112 c, 8112 d in the adjunctmaterial 8105 formed at a proximal end 8105 p are shown. It should beappreciated, however, that, though not shown, the adjunct material 8105also includes two other openings at a distal end thereof that correspondto the projections 8110 a, 8110 b formed on the tissue-facing surface8106 of the anvil 8102 at the anvil's distal end 8102 d.

The adjunct material 8105 also has one or more retaining features thatreleasably retain the adjunct material 8105 on the jaw 8102. In theillustrated example, such features are in the form of a layer 8107 of anadhesive material disposed on the jaw-facing surface of the adjunctmaterial 8105, as shown in FIG. 60. The adhesive material layer 8107 canbe formed on the entirety of the adjunct material 8105 or it can bedisposed on one or more portions of the adjunct material 8105. Theadhesive material layer 8107 can be formed from any suitable material.For example, the adhesive material can be polydioxanone (PDO), a lowmolecular weight polyethylene glycol (PEG) or any other material (or acombination of materials) that can be used to attach the adjunct to thejaw. In some embodiments, the adhesive material can be a bioabsorbableand/or biodegradable pressure sensitive adhesive.

The female features of the adjunct material 8105 and the male featuresformed on the anvil 8102 can have many different configurations and thefemale and male features can mate in a variety of different ways. Inthis example, the female features of the adjunct material 8105 in theform of openings are configured to encompass the male features in theform of projections formed on the anvil 8102 in a clearance fit suchthat the adjunct material 8105 is able to move with respect to the anvil8102 at least in a first plane 8114 parallel to the tissue-facingsurface 8106 of the anvil 8102, which is schematically shown in FIG. 59.It should be appreciated, however, that the movement of the adjunctmaterial 8105 in the first plane 8114 is restricted to the extent thatcorresponds to a degree of the clearance fit between the female and malefeatures.

As shown in FIG. 60 illustrating a portion of the end effector 8100, theprojection 8110′, representing the projections 8110 a, 8110 b, 8110 c,8110 d formed on the tissue-facing surface 8106 of the anvil 8102, istapered in a direction that is perpendicular to a longitudinal axis 8A1of the jaw 8102. As further shown in FIG. 60 illustrating a portion ofthe end effector 8100, an opening 8112′ in the adjunct material 8105(e.g., any of the openings 8112, 8112 d, or other openings) is oversizedwith respect to a corresponding projection 8110′ (e.g., any of theanvil's projections 8110 a, 8110 b, 8110 c, 8110 d) formed on the anvil8102. As a result, the opening 8112′ encompasses the projection 8110′ ina clearance fit such that the adjunct material 8105 is able to move withrespect to the anvil 8102 at least in the first plane 8114 shown in FIG.59. When the opening 8112′ is generally round in shape, as in theillustrated example, its diameter is larger than a largest dimension ofthe projection 8110′ in the plane parallel to a plane of thetissue-contacting surface of the jaw.

The configuration and size of the female feature in the form of theopening 8112′ is such that the male feature in the form of theprojection 8110′ encompassed by opening 8112′ is not effective to retainthe adjunct material 8105 in a second plane 8116 that is perpendicularto the first plane 8114. Thus, the projection 8110′ is encompassed bythe opening 8112′ such that, if the jaw 8102 with the adjunct 8105mounted thereon were to be turned upside down, and if the projection8110′ and the opening 8112′ were the only features used to position theadjunct 8105 over the jaw (which is not the case), the adjunct 8105would slide off the jaw 8102 with little or no force. It should beappreciated that the planes 8114, 8116 are referred to as “first” and“second” for purposes of description only, and not to indicate anyparticular order.

As mentioned above, the adjunct material 8105 and the female featuresformed thereon can have various configurations. In the exampleillustrated, the openings (e.g., the openings 8112 c, 8112 d shown inFIG. 59) in the adjunct material 8105 are generally circular in shapeand they have a diameter that allows them to encompass the projections(e.g., the projections 8112 c, 8112 d) formed on the jaw 8102 in aclearance fit. However, it should be appreciated that the adjunctmaterial 8105 can have openings having other shapes, which can bedifferent from circular (e.g., oval, rectangular, square, or irregularshapes). Also, the adjunct material can include openings having the samesize, or openings of different sizes and/or shapes can be formed in theadjunct material.

The male features, such as the projections 8110 a, 8110 b, 8110 c, 8110d formed on the tissue-facing surface 8106 of the anvil 8102, can beformed at any suitable locations on the anvil 8102. The projections canbe formed within an area of the tissue-facing surface 8106 occupied bythe staple-forming pockets 8104, or the projections can be formedoutside of this area. Thus, in the example of FIG. 59, the projections8110 a, 8110 b formed at the distal end 8102 d of the anvil 8102 areoffset distally from the staple-forming pockets 8104. The projections8110 c, 8110 d formed at the proximal end 8102 p of the anvil 8102 canbe formed within the anvil's area having the staple-forming pockets8104. However, in some embodiments, the projections 8110 c, 8110 d canbe formed on the area of the anvil 8102 outside of the area having thestaple-forming pockets 8104.

In some implementations, as mentioned above, the projections on thetissue-facing surface of a jaw of the anvil can be formed within thearea of the anvil having the staple-forming pockets such that theprojections are formed between the staple-forming pockets. The adjunctmaterial used in conjunction with the anvil having such projections canhave corresponding female features disposed at locations of the adjunctmaterial such that the female features can encompass the male featuresin a clearance fit. Furthermore, a cartridge of an end effector can havemale features formed within the cartridge's area having the staplepockets (e.g., between the pockets), of the male features can be formedoutside of the area having the staple pockets.

A jaw of an end effector can have any suitable number of male featuresconfigured to mate with corresponding adjunct's female features usingthe described techniques—in a non-retaining manner. The four projections8110 a, 8110 b, 8110 c, 8110 d formed on the tissue-facing surface 8106of the anvil 8102 are shown in FIG. 59 by way of example only. Thus,one, two, three, or more than four projections configured to mate withcorresponding female features formed on the adjunct. In embodiments inwhich one projection is used, it can be in the form of an elongate,narrow feature, such as a rib or a slot. Alternatively, if the adjunctis configured to be constrained proximally by the end effector (e.g.,between the tissue stops of the anvil), a single distal attachment pointmay be sufficient to apply the adjunct to the jaw. Furthermore, in someembodiments, at least one of the female features can be configured suchthat a single female feature encompasses more than one male feature. Forexample, one opening formed in the adjunct material can encompass in aclearance fit two or more male features formed on an anvil or on acartridge.

The non-retaining male and female features (i.e., the featuresconfigured to mate such that an adjunct can move with respect to the jawon which it is mounted at least in the first plane parallel to thetissue-facing surface, and such that the adjunct is not retained in thesecond plane that is perpendicular to the first plane) can have variousconfigurations. Thus, the projections and openings are shown in FIGS. 59and 60 by way of example only.

It should be appreciated that retaining attachment features (i.e.,features configured to retain the adjunct with respect to the jaw onwhich it is mounted such that the adjunct cannot move in the first andsecond planes and can only be separated from the jaw when the staplesare ejected) can also have various configurations. As discussed above,in the example shown in FIGS. 59 and 60, the attachment feature is theadhesive layer 8107 formed on the jaw-facing surface of the adjunct.Other attachment feature(s) can be used additionally or alternatively,as the described techniques are not limited to any specific attachmentfeatures configured to releasably retain the adjunct on the jaw. Forexample, the jaw can have one or more projections or other male featuresthat can serve as the attachment features configured to mate withrespective female features formed on the adjunct material. In someimplementations, the attachment male features formed on the adjunct canbe configured to mate with complementary female features formed on thejaw. Furthermore, different types of features (e.g., both female andmale or combination(s) thereof) can be formed on the adjunct, which canmate with corresponding features of the jaw. The described techniquesare also not limited with respect to a number of the attachment featuresand to specific locations of the attachment features on the jaw and onthe adjunct material.

FIG. 61 illustrates another example of a distal portion of an endeffector having features in accordance with the described techniques.The end effector can be used with any suitable surgical instrument. Forexample, it can be used with a linear surgical stapler, such as stapler10 in FIG. 1, stapler 50 in FIG. 4, or any other surgical stapler. Inthis example, a jaw in the form of the cartridge 8202 of the endeffector having staple pockets 8204 formed on a tissue-contactingsurface 8206 thereof is shown. The staple pockets 8204 form several rowsalong a longitudinal axis 8A2 of the cartridge 8202. The cartridge 8202can be a removable and replaceable cartridge. In some embodiments, thecartridge 8202 can be part of a replaceable and disposable loading unitconfigured to couple distally to a shaft (not shown) of the endeffector.

As shown in FIG. 61, the tissue-contacting surface 8206 of the cartridge8202 has male features in the form of multiple projections 8210 formedalong a long side of the cartridge 8202. In this example, theprojections 8210 form two rows on opposite sides of the area of thetissue-contacting surface 8206 having the staple pockets 8204, with therows extending parallel to the longitudinal axis 8A2 of the cartridge8202. Any suitable number of projections can be formed at a suitabledistance from one another. The projections 8210 can be in the form ofposts having a rounded and/or tapered head. It should be appreciated,however, that the projections 8210 can have any suitable configurations.

As also shown in FIG. 61, the cartridge 8202 can retain thereon anadjunct material 8205 having female features configured to mate with thejaw's male features in the form of the projections 8210 such that eachfemale feature can encompass a corresponding one of the male features ina clearance fit. In this way, the adjunct material 8205 is able to movewith respect to the jaw 8202 at least in a first plane 8214 parallel tothe tissue-facing surface 8206 of the jaw 8202.

In the example of FIG. 61, the adjunct 8205 is formed from at leastpartially stretchable or expandable material formed of fibers such thatat least some portions of the adjuncts are relatively loose. Forexample, the adjunct can be a fiber-based lattice which can be a wovenfabric, knitted fabric or non-woven fabric. The adjunct can havemultiple regions that can be formed from the same type of lattice orfrom different types of lattices that can together form the adjunct in anumber of different ways. For example, the fibers can be woven, braided,knitted, or otherwise interconnected so as to form a regular orirregular structure. The fibers can be interconnected such that theresulting adjunct is relatively loose.

The expandable material can be, e.g., in the form of a mesh materialhaving fibers forming regular or irregular patterns, or a combination ofregular or irregular patterns. The adjunct 8205 has a plurality offemale features in the form of expandable openings 8212 formed betweenfibers of the expandable material. The openings 8212 can be preformed inthe adjunct material 8205 such that they are formed at predeterminedlocations. For example, the openings 8212 can be formed in two rowsalong opposite long sides of the adjunct material 8205, as shown in FIG.61. In some embodiments, the expandable openings can exist in theadjunct material 8205 due to the nature of the fabric from which theadjunct material is formed. As mentioned above, the entire adjunctmaterial or one or more portions thereof can be relatively looselyinterconnected, and such loosely interconnected portions can haveopenings therein. In such embodiments, the male features formed on thejaw can “find” openings in the adjunct to mate with when the adjunct isplaced over the jaw.

Regardless of the specific way in which the female features are formedin the adjunct material, the adjunct material can mate with the malefeatures formed on the jaw because the expandable material stretches(e.g., its fibers separate) and thus enlarges in places where the malefeatures are inserted at least through the mesh. FIGS. 62A, 62B, and 62Cillustrate an example of openings 8212′ in an adjunct material 8205′that can encompass posts or projections 8210′ formed on a jaw, such asthe cartridge 8202 or other jaw (which can be an anvil).

As shown in FIG. 62A, openings 8212′ in an adjunct material 8205′, threeof which are labeled as openings 8217 a, 8217 b, 8217 c, can be presentin the expandable material forming the adjunct material 8205′ due to theway in which the fibers of the adjunct material are interwoven. Theopenings 8217 a, 8217 b, 8217 c exist between the interwoven fibers ofthe adjunct material 8205′ and each can be expanded, enlarged, ordeformed when it receives a respective projection therein. FIG. 62Billustrates by way of example of three projections 8219 a, 8219 b, 8219c of the multiple projections that can be formed on the jaw, such as thecartridge 8202 in FIG. 61 or other jaw.

When the adjunct material 8205′ is laid over the jaw, the projections8219 a, 8219 b, 8219 c are received within the openings 8217 a, 8217 b,8217 c such that the material forming the adjunct material 8205′stretches over the projections 8219 a, 8219 b, 8219 c in directionindicated by arrows 8220 a, 8220 b, as shown in FIG. 62C. The propertyof the material is such that it is stretched and/or deformed so that theadjunct material 8205′ is able to move with respect to the jaw at leastin a first plane parallel to the tissue-facing surface of the jaw and sothat the adjunct material is not retained in a second plane that isperpendicular to the first plane.

In addition to female features described above, the adjunct material8205 in FIG. 61 and the adjunct material 8205′ shown in FIGS. 62A and62C also have at least one attachment feature configured to releasablyretain the adjunct material on the jaw. The at least one attachmentfeature can be an adhesive material layer formed over at least a portionof the adjunct material, or any other type of feature(s), such as a maleor female feature, or a combination thereof. The at least one attachmentfeature can be configured to mate with the end effector's jaw on whichthe adjunct is mounted, in a way corresponding to a type of theattachment feature. For example, when the attachment feature is theadhesive material layer, such adhesive material layer attaches to thejaw due to its adhesive nature. When the attachment feature is one ormore openings or projections, they are configured to mate withcorresponding projections or openings formed on the jaw.

Regardless of the specific type, number, and location of attachmentfeature(s) formed on the adjunct material, they are formed to retain theadjunct material on the jaw in three dimensions, such that the adjunctcan be separated from the jaw when the staples are ejected from thecartridge. The adjunct's non-retaining features (e.g., various femalefeatures described herein), which do not retain the adjunct with respectto the jaw in the plane perpendicular to a plane parallel to the jaw'stissue-contacting surface, are used to prevent stretching of the adjunctmaterial and/or displacement (e.g., slipping or sliding off) of theadjunct from the jaws of the end effector. Thus, unlike thenon-retaining adjunct's features that are only used to properly positionthe adjunct, the attachment features serve to releasably retain theadjunct on the jaw.

In some embodiments, an adjunct material is formed from fibers and itcomprises a backing layer non-removably attached thereto on a side ofthe adjunct material facing the jaw. The fibers can be a mesh, nonwovenfibers, or any other type(s) of fibers. The backing layer can havefemale features formed thereon for mating with respective male featuresformed on the jaw on which the adjunct material is mounted. FIGS. 63 and64 illustrate example of such adjunct material, with the jaw not shown.

FIG. 63 illustrates an example of an adjunct material 8300 in the formof a generally rectangular fiber layer. The adjunct material 8300 has abacking layer 8302 non-removably attached thereto on a side of theadjunct material facing the jaw of an end effector. As shown in FIG. 63,the backing layer 8302 has a plurality of female features in the form ofopenings 8304 formed thereon. The openings 8304 can mate withcorresponding male features of the jaw (e.g., a cartridge or anvil). Inthis example, the openings 8304 are configured to mate with the malefeatures such that not every opening mates with the jaw. Thus, a patternand/or number of male features formed on the jaw may be different from apattern and/or number of female features formed on the adjunct material.For example, the jaw can have fewer male features (e.g., projectionssuch as projections 8110 (FIG. 59), projections 8210 (FIG. 61), or anyother male features) than the number of openings. In this way, forexample, only some of the openings 8304 (which are oversized withrespect to the male features) may surround respective male features.Thus, there is no requirement that specific openings surround specificmale features. The adjunct material 8300 with multiple openings formedtherein can thus be easily positioned over the jaw and the male features“find” openings that can surround the male features. The number of themale features can be selected such that it is sufficient to preventdisplacement of the adjunct material from the end effector's jaw(s), inaccordance with the described techniques.

The openings 8304 can have any suitable configuration. For example,while generally circular openings 8304 are shown in FIG. 63, theopenings can be oval, rectangular, square, or they have can otherregular or irregular shapes. Any suitable number of openings can beformed in any suitable pattern(s).

The backing layer 8302 can be formed from any suitable biodegradableand/or bioabsorbable material, such as, for example, polydioxanone (PDO)or any other suitable polymeric material(s). The material can beselected such that it biodegrades and/or bioabsorbs faster than theadjunct material 8320. As shown in FIG. 63, the backing layer 8302 has athickness that is smaller than that of the adjunct material 8320. Forexample, in some embodiments, the height or thickness 8 h 1 of theadjunct material 8320 can be from about 0.004 inches to about 0.020inches, whereas the height or thickness 8 h 2 of the backing layer 8302can be from about 0.0002 inches to about 0.0012 inches. However, in someembodiments, the thickness 8 h 1 of the adjunct material can begreater—e.g., from about 0.01 inches to about 0.150 inches. Thethickness 8 h 1 of the adjunct material, as well as the thickness 8 h 2of the backing layer, can vary within other suitable ranges.

FIG. 64 illustrates another example of an adjunct material 8400 in theform of a generally rectangular fiber layer. The adjunct material 8400has a backing layer 8402 non-removably attached thereto on a side of theadjunct material 8400 facing a jaw of an end effector (not shown). Asshown in FIG. 64, the backing layer 8402 has a plurality of femalefeatures in the form of openings 8404 formed thereon. The openings 8404can mate with corresponding male features of the jaw (e.g., a cartridgeor anvil). The openings 8404 can be configured to mate with the malefeatures such that one opening can surround two or more male features.Thus, as illustrated in FIG. 64, the backing layer 8402 has several(e.g., two, three, or greater than there) openings formed therein eachof which can surround more than one male feature (e.g., projections,posts, etc.) formed on the jaw. For example, one opening (or “window”)8404 can surround a group of jaw's male features. Also, in someembodiments, only some of the openings 8404 will surround two or moremale features.

Furthermore, in some embodiments, the backing layer can have oneopening. For example, it can be a relatively large opening such that thebacking layer can be in the shape of a frame that is coupled to theadjunct material along a perimeter of the adjunct. The frame-shapedbacking layer can couple with a jaw via male features disposed on thejaw in a certain manner. For example, four or more male features (e.g.,posts) can be disposed at opposed sides at the distal and proximal endsof the jaw and the frame-shaped backing layer, with the adjunct coupledthereto, can be retained on the jaw via such features received withinthe opening in the backing layer.

The openings 8404 can have any suitable configuration and size. Forexample, as shown in FIG. 64, the openings 8404 can be rectangular.However, they can alternatively be square, round, oval, etc. Also, theadjunct material can have openings of different sizes and/or shapes. Thebacking layer 8402 can be formed from one or more materials similar tothe backing layer 8302 in FIG. 63.

Furthermore, although not shown separately in FIGS. 63 and 64, each ofthe adjunct materials 8300 and 8400 also includes one or more attachmentfeatures configured to releasable retain the adjunct material on thejaw. The attachment feature(s) can be in the form of an adhesivematerial layer, female, male, or other type of features that are used toretain the adjunct material on the jaw in all three dimensions.Furthermore, in some embodiments, the material from which the backinglayer (e.g., backing layer 8302 in FIG. 63 or backing layer 8402 in FIG.64) is formed can be an adhesive material serving as an attachmentlayer. The adhesive material can be any suitable polymer, such aspolydioxanone (PDO), a low molecular weight polyethylene glycol (PEG) orany other material (or a combination of materials) that can be used toattach the adjunct to the jaw. In some embodiments, the adhesivematerial can be a bioabsorbable and/or biodegradable pressure sensitiveadhesive.

In the example of FIGS. 63 and 64, the backing layer non-removablyattached to the adjunct material on jaw-facing surface thereof is formedsubstantially over entire surface of the adjunct material. In someembodiments, the backing layer can be in the form of discrete portions.In this way, while some portions of the adjunct material can beprevented from being stretched, other portions can be stretched once theadjunct material is applied to tissue at a treatment site. The adjunctmaterial can thus move with the tissue at which it is implanted when thetissue moves, while remaining being coupled to the tissue. This may bedesirable when tissue such as, for example, lung is being treated, whichneeds to be able to expand and contract to perform its function.Allowing the implanted adjunct material to stretch to some degree allowsthe tissue to heal appropriately.

FIGS. 65 and 66 illustrate an example of an adjunct material 8500 to bedisposed over a jaw 8501 which is, in this example, a cartridge. Theadjunct material 8500 can however be disposed over an anvil as well. Asshown in FIG. 65, the adjunct material 8500 has discrete portion orpanels 8502, 8502 b, 8502 c forming a backing side or layer 8502. Asshown, the panels 8502, 8502 b, 8502 c non-removably attached to theadjunct material 8500 are disposed perpendicular to a longitudinal axis8A3 of the adjunct material 8500. It should be appreciated that threepanels 8502, 8502 b, 8502 c are shown by way of example only, as two orgreater than three panels can span the adjunct material 8500 along ashort side thereof.

The adjunct material 8500 can be formed from any suitable materialdescribed herein, which can be a mesh or a non-woven material. Thebacking layer 8502 can also be formed from any suitable material, suchas a biodegradable and/or bioabsorbable material, e.g., polydioxanone(PDO) or any other suitable polymeric material(s). The material can beselected such that it biodegrades and/or bioabsorbs faster than theadjunct material 8500. The backing layer 8502 has a thickness that issmaller than that of the adjunct material 8500. For example, in someembodiments, the height or thickness of the adjunct material 8500 can befrom about 0.004 inches to about 0.020 inches, whereas the height orthickness of the backing layer 8502 can be from about 0.0002 inches toabout 0.0012 inches.

As shown in FIG. 66, illustrating by way of example a back side of theadjunct material 8500 with the panels 8502, 8502 b, 8502 c when theadjunct material 8500 is retained at the treatment side (the staples andtissue are not shown), the panels 8502, 8502 b, 8502 c preventstretching of the portions of the adjunct material 8500 to which thepanels 8502, 8502 b, 8502 c are attached. As also shown, the portions ofthe adjunct material 8500 between the panels 8502, 8502 b, 8502 c, suchas portions 8503 a, 8503 b in FIG. 64, can stretch along thelongitudinal axis 8A3 of the adjunct material 8500 once implanted ontissue. Thus, while the panels 8502, 8502 b, 8502 c prevent undesirableexcessive stretching and displacement of the adjunct material 8500 atthe treatment site, the portions of the adjunct material 8500 betweenthe panels allow the adjunct stretching where desired.

It should be appreciated that the number, size, and location of thepanels configured to prevent stretching of portions of the adjunctmaterial can be selected to create a desired pattern of areas at whichthe adjunct is coupled to the jaw (e.g., the areas coupled to thepanels) and areas at which the adjunct is allowed to stretch onceimplanted. In some embodiments, adjunct(s) that are at least partiallystretchable at some portions thereof can be used in conjunction with astaple line that can be flexible as described, for example, in theabove-mentioned U.S. Pat. Pub. No. 2016/0089142 entitled “Method forCreating a Flexible Staple Line,” and filed on Sep. 26, 2014, which ishereby incorporated by reference herein in its entirety. Suchimplementations can be used for treatment of tissue which contracts andexpands, such as lung. Furthermore, in some embodiments, the panels,such as the panels 8502, 8502 b, 8502 c, can be aligned with somestaples and not others along the longitudinal length of the jaw. Also,when the adjuncts with the backing layer panels are disposed on bothjaws of an end effector, the panels formed on the opposed adjuncts canhave a pattern (e.g., a complementary pattern) such that a staple, onceejected, passes only through one of the backing layers. The panels andspacing between panels can be selected such that the panels formirregular and non-uniform patterns, and adhesive is applied to thepanels.

As in other examples illustrating the described techniques, the adjunctmaterial 8500 also includes one or more attachment features which can bein the form of an adhesive material layer formed at the jaw-facingsurface of the panels 8502, 8502 b, 8502 c. Other attachment featurescan be formed additionally or alternatively. Furthermore, in someembodiments, the material from which the panels 8502, 8502 b, 8502 c areformed can be an adhesive material serving as an attachment layer. Theadhesive material can be any suitable polymer, such as polydioxanone(PDO), a low molecular weight polyethylene glycol (PEG) or any othermaterial (or a combination of materials) that can be used to attach theadjunct to the jaw. In some embodiments, the adhesive material can be abioabsorbable and/or biodegradable pressure sensitive adhesive.

It should be appreciated that the adjunct materials described herein canbe used with various types of end effectors that can be used in linearor circular stapler instruments. For example, it can be used in a linearsurgical stapler, such as stapler 10 in FIG. 1 or stapler 50 in FIG. 4,or in a circular surgical, such as stapler 80 in FIG. 5, or in any othersurgical stapler instrument. Thus, although generally rectangularadjuncts are shown in FIGS. 59, 61, 63, 64, 65, and 66, the adjuncts canbe created such that they have a generally circular shape and such thattheir retaining and non-retaining features are configured for matingwith an end effector of a circular stapler instrument. Also, asmentioned above, the adjunct can have or can be associated with varioustypes “retaining” and “non-retaining” features.

Furthermore, the adjunct materials described herein can include one ormore medicants which can be releasably incorporated into or associatedwith adjuncts in many different ways. Also, the adjunct materials canhave various other features in addition to the features describedherein.

Systems for Release of Adjunct in a Surgical Stapling Device

Implantable adjuncts can be releasably attached to a jaw of an endeffector of a surgical stapling device. The coupling can be done invarious ways, for example, adhesives and/or adhesive features can beused to couple the adjunct to a surface of the jaw. This can allowmanipulating the end effector with the adjunct during a surgicalprocedure, while the adjunct is prevented from being prematurelyseparated from the surface of the jaw before the adjunct is stapled to atissue. After the adjunct has been stapled to the tissue, the adjunctcan be detached from the jaw by a force exerted by the tissue (e.g.,shearing force, pull, etc.). Attaching systems (e.g., those usingpolydioxanone adhesives) that attach the adjunct to the surface of thejaw in a secure (strong) manner can be advantageous as they ensure thatthe adjunct does not slip or slide off the jaw's surface prior to thestapling to the tissue. A strong attachment however can make the adjunctremoval process challenging. This challenge can be obviated by includingan adjunct removal mechanism or assembly in a jaw of the surgicalstapling device that is configured to separate the adjunct from the jaw.

Accordingly, an adjunct removal mechanism can be configured to detachthe adjunct from the surface of the jaw of the surgical stapler deviceafter the adjunct has been stapled to the tissue. This can be done forexample, by using a motion of a firing bar (in the surgical staplingdevice) from a fired position at the distal end of the end effector toan unfired position at the proximal end of the end effector. The firingbar can couple to the adjunct removal mechanism at the distal end, andreturn back to the proximal end (i.e., unfired position) with theadjunct removal mechanism. The adjunct removal mechanism can include anadjunct removal feature that separates the adjunct from the jaw of thesurgical stapler device as the adjunct removal mechanism moves from thedistal to the proximal end.

FIG. 67A illustrates an example of an adjunct 9502 releasably retainedto a tissue facing surface of a lower jaw 9504 of an end effector of asurgical stapler device. One or more portions of the adjunct 9502 can beattached to the lower jaw 9504 by an adhesive 9508. The adhesive 9508can be disposed at any suitable pattern—for example, it can bedistributed between the adjunct 9502 and lower jaw 9504 at distal andproximal ends of the adjunct 9502, as shown in FIG. 67A. The adhesivecan be, for example, a pressure sensitive adhesive (PSA). Additionallyor alternately, a second adhesive, for example, cyanoacrylate (CA), canattach the adjunct 9502 to the tissue facing surface of the lower jaw9504. For example, as shown in FIG. 67A, one or more portions of theadjunct 9502 can be coupled to the jaw 9504 via attachment portions orpoints 9506 formed from the second adhesive. It should be appreciated,however, that the first and second adhesives can be the same material(e.g., a PSA, CA, etc.), or a combination of suitable materials. Theadjunct 9502 can be attached to the lower jaw 9504 by variousmechanisms, for example, as described in U.S. patent application Ser.No. 15/436,183 entitled “Hybrid Mechanism for Attachment of an Adjunctto a Surgical Instrument” filed on even date herewith, the entirecontent of which is incorporated herein by reference.

As shown in FIG. 67A, the lower jaw 9504 includes a knife channel 9509that extends longitudinally along the length of the lower jaw 9504. Theattachment points 9506 of the second adhesive (or any other adhesive)can be distributed, for example, along and/or around the knife channel9509. It should be appreciated however that four attachment points 9506are shown by way of example only, as any suitable number of attachmentpoints can be formed at any desired pattern(s). Further, in someembodiments, the attachment points, which can be configured to be brokenby a suitable release mechanism, can be formed at areas at which theadjunct was heated and pressed onto the jaw and allowed to cool and thusconform to the geometry of the jaw. In this way, one or more portions ofthe adjunct mechanically “grip” the jaw (in some cases, in certaintextured or roughened portions of the jaw).

FIG. 67B illustrates the surgical stapler device clamping on a tissue9510. The tissue 9510 is clamped between an upper jaw 9512 and the lowerjaw 9504 of the stapler. The adjunct 9502 lies between the tissue 9510,and the tissue facing surface of the lower jaw 9504. Due to the adjunct9502, portions of the tissue facing surface do not come in directcontact with the tissue 9510. A distal end 9513 of a firing bar 9518(e.g., an I-Beam, an E-Beam, or otherwise configured end) extendsvertically with respect to the tissue facing surface. The distal end9513 includes flanges 9514 configured to scrape the adjunct 9502 fromthe tissue-facing surface of the lower jaw 9504. For example, the flange9514 can cause adhesive 9506 to crack and thereby release portions ofthe adjunct 9502 when the firing bar 9518 moves from the proximal to thedistal end or vice-versa. The flanges 9514 are shown as having slantedsurfaces by way of example, and they can have other configurations.

FIG. 67C illustrates a perspective view of an embodiment of the distalend 9513 of the firing bar 9518. The distal end 9513 includes a knife9516 and the flange 9514. As the distal end 9513 travels from a proximalend to a distal end of the stapler, the knife 9516 cut the tissue 9510.

FIGS. 67A-67C illustrate that a knife of a firing bar assembly can beused to separate an adjunct from a jaw which has the adjunct releasablycoupled thereto. In some embodiments, assemblies having otherconfigurations can be used to separate an adjunct from a jaw of an endeffector in conjunction with movement of the firing bar.

FIGS. 68A and 68B illustrate an example of a jaw 9600 of an end effector9607. The end effector 9607 can be coupled to a distal end of a shaft ofa surgical stapling device (not shown). The end effector 9607 can beused in any suitable surgical instrument, for example, a linear surgicalstapler (e.g., stapler 10 in FIG. 1, stapler 50 in FIG. 4, or any othersurgical stapler, including a circular stapler, such as stapler 80 inFIG. 5) which can be suitable for use with at least one adjunct.

The end effector 9607, shown partially in FIGS. 68A and 68B, has a firstjaw having a cartridge with a plurality of staple cavities configured toseat staples therein, the staple cavities opening on a tissue-facingsurface of the cartridge. For example, the end effector 9607 includesthe jaw 9600 in the form of cartridge having a plurality of staplecavities 9625 configured to seat staples 9623 therein. The staplecavities 9623 open on a tissue-facing surface 9609 of the cartridge9600. Although not shown in FIGS. 68A and 68B, the end effector 9607also includes a second jaw opposing the first jaw in the form of thecartridge 9600 and having an anvil with a plurality of staple formingcavities formed on a tissue-facing surface thereof. The first and secondjaws are configured to clamp tissue therebetween.

The end effector 9607 also includes an implantable adjunct materialreleasably retained on at least one of the first and second jaws. Inparticular, in this example, the jaw 9600 has an adjunct material oradjunct 9610 releasably retained on the tissue facing surface 9609thereof. Although the jaw 9600 is also referred to herein as acartridge, it should be appreciated that the jaw 9600 can have a staplechannel configured to support a staple cartridge, which can be removablyand replaceably seated within the staple channel. In some embodiments,the cartridge 9600 can be part of a disposable loading unit coupleddistally to a shaft of a surgical instrument. The cartridge 9600 can bepart of a cartridge reload assembly that is pre-assembled with anadjunct material. In such embodiments, a suitable adjunct loader can beused to attach an adjunct material to an anvil.

As shown in FIGS. 68A and 68B, the cartridge 9600 includes a firing bar9601 configured to move longitudinally between a proximal end 9602 and adistal end 9603 of the cartridge 9600. The firing bar 9601 moves withina knife channel 9624 formed in the cartridge 9600 that extendslongitudinally along the cartridge 9600 and guides the motion of thefiring bar 9601 between the proximal and distal ends 9602, 9603. Theknife channel 9624 can extend through a cartridge in the lower jaw. Inthe illustrated example, the firing bar 9601 is configured to movebetween an unfired position at the proximal end 9602 of the end effector9607 and a fired position at the distal end 9603 of the end effector9607.

The firing bar 9601 can have a variety of configurations. For example,in the illustrated embodiment, the firing bar 9601 includes at least oneof a knife 9608 and a staple driving assembly 9615 configured to causethe staples 9625 to fire from the staple cavities 9623 against thestaple forming cavities in the anvil (not shown). The distal end of thefiring bar 9601 includes a distal guide 9604. It should be appreciatedthat the firing bar 9601 can have any other components additionally oralternatively.

In use, when tissue is clamped between the jaw 9600 with the adjunct9610 and the anvil of the end effector 9607, as the firing bar 9601moves from the unfired position to the fired position, the knife 9608cuts through the adjunct 9610. During this motion, the guide 9604 canengage a wedge sled (not shown) that pushes the staples 9625 held in thestaple cavity 9623 upwards towards an upper jaw (not shown) of thestapling device. In the process, the staples 9625 can pass through theadjunct 9610 and the tissue into the anvil of the upper jaw that facesthe tissue. When the first and the second jaws clamp on the tissue, thestaple forming cavities of the anvil guide the staples and cause thetissue and the adjunct 9610 to be stapled together.

The adjunct 9610 can be releasably retained on the tissue-facing surface9609 of the cartridge 9600. The adjunct 9610 can be coupled to thetissue facing surface 9609 in various manners. For example, one or moreadhesives (e.g., polydioxanone (PDS), CA, etc.) can be applied betweenthe adjunct 9610 and the tissue-facing surface 9609 to releasably retainthe adjunct 9610 on the cartridge 9600. In some embodiments, a backinglayer made, e.g., of a PDS film, can be used to couple the adjunct 9610to the jaw 9600. The backing layer can include one or more attachmentpoints or portions (e.g., similar to the portions 9506, 9508 in FIG.67A) that can be formed from an adhesive configured to be transitionedto an adhering state under application of heat. In other words, theadhesive can be at least partially melted (using, e.g., a loaderconfigured to apply heat), in which state it can be used to couple theadjunct 9610 directly or via the PDS film to the jaw. When theattachment adhesive cools, it couples the adjunct 9610 (e.g., at one ormore portions) to the jaw 9600 securely. Additionally or alternatively,various other features (e.g., additional polymer layer (s), attachmentfeatures, etc.) can be used to releasably couple the adjunct 9610 to thejaw 9600.

Regardless of the manner in which the adjunct 9610 is coupled to thecartridge 9600, the adjunct 9610 is coupled to the cartridge 9600releasably, such that it is separated from the cartridge 9600 to remainwith the tissue after the tissue stapling and/or cutting is completedduring a surgical procedure. In some embodiments, the adjunct 9610 canbe releasably coupled to the jaw 9600 in a secure manner, such that theend effector can be manipulated as desired, without the risk of theadjunct 9610 sliding or slipping off the jaw 9600. At the same time,such secure attachment can require certain actions to separate theadjunct 9610 from the cartridge 9600.

Accordingly, in the illustrated embodiments, the end effector 9607includes an adjunct removal assembly 9630 configured to separate theadjunct 9610 from the cartridge 9600. The adjunct removal assembly 9630is configured to couple to and move with the firing bar 9601 to separatethe adjunct material 9610 from the end effector 9607 as the firing bar9601 having the adjunct removal assembly 9630 coupled thereto isreturned from the fired position to the unfired position, as discussedin more detail below. For example, as the adjunct removal assembly 9630is moved proximally with the firing bar after the assembly is engaged bythe firing bar, the adjunct removal assembly 9630 can break or crackattachment points (formed, e.g., by a hot-melt adhesive) between theadjunct 9610 and the cartridge 9600. In this way, the adjunct 9610 isseparated from the cartridge.

As shown in FIGS. 68A and 68B, the adjunct removal assembly 9630 isdisposed at the distal end 9603 of the cartridge 9600. The adjunctremoval assembly 9630 is operably associated with the cartridge 9600. Asshown in FIG. 68A, it can be disposed at the distal end 9603 of the endeffector 9607 in a configuration in which the assembly 9630 is notcoupled to the firing bar 9601 when the surgical stapling device is in apre-fired configuration. The adjunct removal assembly 9630 can reside inthe cartridge 9600 and it can move longitudinally along the knifechannel 9624. In use, as the firing bar 9601 moves from the unfiredposition at the proximal end 9603 of the end effector 9607 to the firedposition at the distal end 9602 of the end effector 9607, as shown by anarrow 9605 in FIG. 68A, the adjunct removal assembly 9630 couples tofiring bar 9601 as discussed in more detail below. This movement resultsin the knife 9608 cutting tissue disposed between the jaw 9600 and theanvil (not shown). When the firing bar 9601 moves proximally from thefired position to the unfired position, as shown by an arrow 9652 inFIG. 68B, the adjunct removal assembly 9630 coupled thereto moves withthe firing bar 9601.

The adjunct removal assembly 9630 can have a variety of configurations.In the example illustrated, the assembly 9630 includes an adjunctremoval feature 9614 and a mating feature 9612. The adjunct removalfeature 9614, which can have various configurations, is configured toseparate the adjunct 9610 coupled to the jaw 9600 from the jaw. Themating feature 9612 is configured to mate with a respective matingfeature 9620 included in the firing bar 9601 when the firing bar 9601 isactuated to achieve the firing position.

As shown in FIG. 68A, in a pre-fired configuration of the end effector9607, the adjunct removal feature 9614 is configured to be placedbetween the tissue-facing surface 9609 and the adjunct 9610. As alsoshown, a leading edge 9617 of the adjunct removal feature 9614 isdisposed between the tissue-facing surface 9609 and the adjunct 9610.When the firing bar 9601 has moved to the fired position and couples inthis position to the adjunct removal assembly 9630, and then movesproximally to return to the per-fired configuration, the adjunct removalfeature 9614 slides between the adjunct 9610 and the tissue facingsurface 9609 thereby separating the adjunct 9610 from the jaw 9600, asshown in FIG. 68B. The leading edge 9617 of the adjunct removal feature9614 facilitates separation of the adjunct 9610 from the jaw 9600. FIG.68B shows the assembly 9630 coupled to the firing bar 9601 being pulledby the firing bar 9601 towards the proximal end 9602 of the end effector9607. As the adjunct removal feature 9614 slides, it causes the adjunct9610 to separate from the tissue facing surface 9609 of the jaw 9600.

The mating feature 9612 of the assembly 9630 is configured to mate withthe mating feature 9620 of the firing bar 9601. The mating features9612, 9620 can be complementary to one another. For example, the matingfeature 9612 of the assembly 9630 can be in the form of one or moreprotrusions, whereas the mating feature 9620 of the firing bar 9601 canbe in the form of one or more openings or cavities configured to matewith the protrusion(s). The protrusions configured to mate with thecavity in the firing bar can include, e.g., a pair of bars disposed suchthat the firing bar sits between the bars when the adjunct removalassembly 9630 is coupled to and moves with the firing bar. Inparticular, the bars can have a gap between them, as shown, for example,in FIG. 69 (pair of bars 9714 a, 9714 b). In use, the distal end of thefiring bar 9601 can slide into the gap between the pair of bars of themating feature 9612. FIG. 68B illustrates schematically (a circle 9632)the mating feature 9612 of the assembly 9630 coupled to the matingfeature 9620 of the firing bar 9601. For example, the bars are snappedinto the mating feature 9620 (e.g., a cavity), which can be assisted bymating elements or features that can be formed on the bars.

An example of a surgical method in accordance with the describedtechniques includes actuating the firing bar 9601 so as to move it froman unfired position at the proximal end of the end effector to the firedposition in the distal end of the end effector. The adjunct removalassembly 9630 is engaged with the firing bar 9601 when the firing bar9601 is in the fired position, and the firing bar 9601 is actuated toreturn it from the fired position to the unfired position such that, asthe firing bar 9601 is actuated to return to the unfired position, theadjunct removal assembly 9630 is moved with the fired bar 9601 andthereby causes the adjunct material 9610 releasably retained on the jaw9600 to be separated from that jaw.

It should be appreciated that the adjunct removal assembly 9630 is shownin FIGS. 68A and 68B to be operatively coupled to the cartridge 9600 byway of example only. Thus, in some implementations, an adjunct can beattached to a tissue-facing surface of a jaw of the surgical staplingdevice having an anvil. In such implementations, the adjunct removalassembly can be configured to be operatively coupled to the anvil suchthat it can slide longitudinally with a firing bar to separate theadjunct from a tissue-facing surface of the anvil. It should beappreciated that the adjunct may not be entirely removed from the jawuntil the jaws are unclamped. Thus, the adjunct can be associated withthe jaw (e.g., held against the jaw, albeit not coupled to the jaw)until the jaws are unclamped. Once the jaws are separated, the adjunctcan be fully separated therefrom.

An adjunct removal assembly used to separate an adjunct material from ajaw of an end effector in accordance with the described techniques canhave a variety of configurations. FIG. 69 illustrates an example of aportion of an adjunct removal system or assembly 9710. The adjunctremoval assembly 9710 can be similar, for example, to adjunct removalassembly 9630 in FIGS. 68A and 68B. The adjunct removal assembly 9710includes a stripper plate 9712, a mating feature 9714, and a pair ofposts 9713 a, 9713 b coupling the stripper plate 9712 to the matingfeature 9714. The stripper plate 9712 serves as an adjunct removalfeature, and it can have various configurations. In this example, it isgenerally rectangular, includes an adjunct-facing surface 9708 and aleading surface 9712 b disposed at an angle with respect to the surface9708 and having a sharp leading edge that can facilitate the removal ofthe adjunct from the tissue facing surface of the cartridge. Theadjunct-facing surface 9708 is configured to have an adjunct disposedthereon.

As shown in FIG. 69, the stripper plate 9712 is coupled to the pair ofelongate posts 9713 a, 9713 b that can be attached to a mid-portion orapproximately mid-portion of a side of the stripper plate 9712 that isopposed to the adjunct-facing surface 9708. The mating feature 9714 alsoincludes a pair of bars 9714 a, 9714 b extending from the ends of theposts 9713 a, 9713 b, respectively, that are opposed to the ends of theposts coupled to the stripper plate 9712. As shown in FIG. 69, the bars9714 a, 9714 b extend from the posts 9713 a, 9713 b such that the bars9714 a, 9714 b form a gap 9715 therebetween. As shown in FIG. 69, theposts 9713 a, 9713 b also include a gap therebetween, and the gap 9715can extend between the posts 9713 a and 9713 b. The bars 9714 a and 9714b include mating features 9716 a, 9716 b, respectively (e.g., in theform of hooks facing one another), which can slide into a cavity in thedistal end of the firing bar (not shown). As the distal end of thefiring bar slides between the mating feature 9714 (into the gap 9715),it can push the bars 9714 a, 9714 b in an outward lateral direction.This can generate stress in the inward lateral direction that can causethe hook features 9716 a, 16 b to snap inwards into the cavity in thedistal end of the firing bar. The mating feature 9714 can also guide theadjunct removal assembly 9710 through the knife channel as the adjunctremoval system slides longitudinally with the firing bar.

FIG. 70 illustrates a top view of an example of a jaw 9800 of an endeffector 9807 that can be coupled to a suitable surgical stapler device(not shown). The jaw 9800 is in the form of a cartridge and it can havean adjunct (not shown) removably coupled thereto. The jaw 9700 can besimilar to jaw 9600 in FIGS. 68A and 68B and is therefore not describedin detail. The end effector 9807 includes an adjunct removal assembly9830, shown schematically within a dashed area 9815, that can be similarto adjunct removal assembly 9830 shown in FIGS. 68A and 68B. Thus, asshown in FIG. 70, the adjunct removal assembly 9830 includes an adjunctremoval feature 9814 and a mating feature 9812 configured to mate with acorresponding mating feature of a firing bar (not shown) when the firingbar is actuated to achieve a firing position.

The adjunct removal feature 9814 is shown disposed along a tissue-facingsurface 9809 of the cartridge 9800. The mating feature 9812 of the ofthe adjunct removal assembly 9830 can guide the assembly 9830 along aknife channel 9824 when the adjunct removal assembly 9830 is coupled toand moved with the firing bar from a distal end 9802 to a proximal end9803 of the end effector 9807. As shown by way of example only, thetissue-facing surface 9809 of the jaw 9800 can include features (e.g.,rough surfaces 9862) that can facilitate attachment of the adjunct (notshown) to the jaw 9800. For example, the rough surfaces 9862 can providetraction to the adjunct and can thus allow an adhesive layer (which canhave various features) between the adjunct and the surface 9809 to forma stronger bond.

FIG. 71 illustrates the cartridge 9800 with an adjunct 9810 removablyretained thereon. The adjunct removal assembly 9830 is shown partiallyand FIG. 71 illustrates a relative orientation of adjunct 9810 and theadjunct removal feature 9814 of the adjunct removal assembly 9830. Inparticular, in a pre-fired configuration of the end effector 9807, theadjunct removal feature 9814 is disposed between the jaw 9800 and theadjunct 9810. As illustrated, the adjunct removal feature 9814 has asharp leading edge 9864 that can scrape the adjunct 9810 from the tissuefacing surface 9809 of the cartridge 9800. As discussed above, in afired configuration, the adjunct removal assembly couples to and moveswith a firing bar (not shown) to separate the adjunct material from thecartridge 9800 as the firing bar having the adjunct removal assemblycoupled thereto is returned from the fired position to the unfiredposition.

It should be appreciated that, an adjunct material can be releasablycoupled to at least one jaw of an end effector using various techniques.For example, as mentioned above, the adjunct material can be coupled tothe jaw using an adhesive configured to transition from a non-adheringstate to an adhering state under application of heat. Non-limitingexamples of the systems that can be used to releasably couple theadjunct material to a jaw of an end effector are described in a U.S.patent application Ser. No. 15/436,328 entitled “Systems for CouplingAdjuncts to an End Effector” and filed on even date therewith, thecontent of which is incorporated by reference herein in its entirety.

It should also be appreciated that an adjunct removal assemblyoperatively coupled to an end effector can have a variety ofconfigurations. For example, in some embodiments, the adjunct removalassembly can include a cutting element, such as a suture, string, orwire, that is “picked up” by a firing bar (e.g., by a knife) as thefiring bar returns to an unfired position. As adjunct removal assemblyis moved proximally with the returning firing bar, the cutting elementseparates the adjunct from the jaw.

Hybrid Mechanism for Attachment of an Adjunct to a Surgical Instrument

In general, when using an adjunct in conjunction with a surgicalstapler, the adjunct can be removably attached to the end effector. Theadjunct will preferably remain secured to the end effector while the endeffector is positioned at a treatment site, and is removed from the endeffector when staples are deployed at the treatment site to provide thebenefits discussed above.

It has been observed that adjuncts can prematurely detach from the endeffector prior to staple deployment. Detachment of the adjunct from theend effector can occur in various forms, depending on the manner inwhich the end effector is used. For example, detachment can includevertical lift off of the adjunct from the end effector, lateral slidingof the adjunct with respect to the end effector, and/or curling of theedges of the adjunct from the surface of the end effector. The adjunctcould also slide sideways when an end effector is used to clamp andtwist tissue.

Various exemplary devices, systems, and methods for attaching an adjunctto a surgical instrument are described herein. In general, a hybridattachment mechanism is employed to attach an adjunct to an end effectorjaw of a surgical stapler. In some embodiments, the hybrid attachmentmechanism includes at least two attachment mechanisms, where eachmechanism is configured to inhibit at least one form of adjunctdetachment from the end effector jaw. For example, a first attachmentmechanism can be configured to inhibit vertical removal of the adjunctfrom the jaw. A second attachment mechanism can be configured to inhibitsliding of the adjunct with respect to the jaw. A third attachmentmechanism can be configured to inhibit curling of the adjunct uponitself. Each of the first, second, and third attachment mechanisms canoperate in concert with the others, allowing the hybrid attachmentmechanism to simultaneously inhibit multiple forms of adjunctdetachment. The hybrid attachment mechanism can be further configured todecouple from the end effector jaw, permitting deployment of the adjunctat a treatment site.

Embodiments of the hybrid attachment mechanism are discussed below inconjunction with the stapler 10, where an adjunct is coupled to a tissuecontacting surface 33 of the upper jaw 34 of an end effector 30.However, it may be understood that embodiments of the hybrid attachmentmechanism can be employed with any surgical instrument without limit.Furthermore, embodiments of the hybrid attachment mechanism can beemployed to couple adjuncts with the tissue contacting surface 33 of theupper jaw 34, a tissue contacting surface of the lower jaw 32, andcombinations thereof.

FIGS. 72-74 show an adjunct 10500 disposed upon a tissue contactingsurface 33 (an anvil surface) of an upper jaw 34 including stapleforming pockets 10043 and a hybrid attachment mechanism configured tocouple the adjunct 10500 to the tissue contacting surface 33. The hybridattachment mechanism includes a first attachment mechanism 10502, asecond attachment mechanism 10504, and a third attachment mechanism10506.

In one embodiment, the first attachment mechanism 10502 can beconfigured to maintain the adjunct 10500 on the tissue contactingsurface 33. For example, the first attachment mechanism 10502 can beconfigured to inhibit out-of-plane deformation of the adjunct 10500 andprevent vertical removal of the adjunct 10500 from the tissue contactingsurface 33. In a specific embodiment, the first attachment mechanism canbe an adhesive 10502 (e.g., a biocompatible adhesive) that adheres theadjunct 10500 to the tissue contacting surface 33. As illustrated inFIGS. 72-74, the adhesive 10502 is disposed between the tissuecontacting surface 33 and the adjunct 10500. Adhesives can include, butare not limited to, pressure sensitive adhesives (PSAs), heat activatedadhesives, heat softened adhesives, ultraviolet (UV) cured adhesives,cyanoacrylate-based adhesives, moisture-softened adhesives, andhydrogel-based adhesives.

Mechanical properties of the adhesive 10502 can be selected withinranges suitable to ensure that out-of-plane deformation of the adjunct10500 is inhibited during placement of the surgical stapling device 10at a treatment site and that the adjunct 10500 is released from thetissue contacting surface 33 when secured to tissue by one or morestaples. Examples of suitable mechanical properties can include, but arenot limited to, adhesion strength (peak load) and load-displacementresponse. These mechanical properties can be measured by one or moremechanical tests including, but not limited to, tension, compression,peel (90°, 180°, T), release force, loop tack, shear, and flexureperformed at service temperatures (e.g., within the range between aboutroom temperature and body temperature).

While the first attachment mechanism 10502 can act to inhibitout-of-plane deformation, it may fail to prevent in-plane deformation.For example, the adhesive 10502 can stretch longitudinally in responseto applied in-plane tensile stresses, such as when sliding on tissue orwhen the knife (e.g., knife 36) is fired. As a result, at least aportion of the applied in-plane tensile stress can be felt by theadjunct 10500 and can cause longitudinal elongation of the adjunct10500.

Accordingly, in another embodiment, the second attachment mechanism10504 can be configured to inhibit in-plane (e.g., lateral and/orlongitudinal) sliding or deformation of the adjunct 10500 along thetissue contacting surface 33. In one embodiment, the second attachmentmechanism 10504 can include at least one post 10504 a formed on one ofthe adjunct 10500 and the tissue contacting surface 33 and acorresponding bore 10504 b formed on the other one of the adjunct 10500and the tissue contacting surface 33 that is configured to receive itscorresponding post 10504 a. For example, the bore 10504 b can have adiameter less than, greater than, or approximately equal to that of thepost 10504 a (FIG. 73). By combining the first attachment mechanism10502 and the second attachment mechanism 10504, improved resistance toin-plane sliding or deformation is provided by the hybrid attachmentmechanism.

In order to tailor the degree of resistance to in-plane sliding ordeformation, the number of posts 10504 a, the size of the posts 10504 a,and their relative position with respect to the tissue contactingsurface 33 can be varied. For example, as illustrated in the embodimentof FIGS. 72-74, multiple posts 10504 a, 10504 b are formed on the tissuecontacting surface 33 and multiple respective bores 10504 c, 10504 d areformed on the adjunct 10500. The posts 10504 a have a relatively largerdiameter than the posts 10504 b and are positioned adjacent to theproximal end 10034 p and distal end 10034 d of the jaw 34. As furtherillustrated in the embodiment of FIG. 72, the number of posts 10504 bcan be greater than the number of posts 10504 a. In this configuration,the posts 10504 a can act to inhibit sliding of the corners of theadjunct 10500, while the posts 10504 b can act to inhibit stretching ofthe adjunct 10500 along its length.

Under certain circumstances, ability of the first attachment mechanism10502 or the second attachment mechanism alone to prevent the adjunct10500 from curling upon itself can be impaired in service. For example,in the context of the first attachment mechanism 10502, mechanicalstresses experienced by the adjunct 10500 or the jaw 34 can overcome theadhesion strength of the adhesive. Alternatively, in the context of thesecond attachment mechanism 10504, mechanical stresses experienced bythe adjunct 10500 or the jaw 34 can damage the posts 10504 a. In eithercase, the ability of the first attachment mechanism 10502 or the secondattachment mechanism 10504 to prevent the adjunct 10500 from curlingupon itself can be overcome. Furthermore, it is observed that curling ofthe adjunct 10500 tends to occur most frequently at the distal end 10034p of the jaw 34 because the distal end 10034 p of the jaw can frequentlyexperience elevated stresses due to contact with tissue during use ofthe end effector 30.

Thus, in another embodiment, the third attachment mechanism 10506 can beconfigured to inhibit in-plane movement or deformation of the adjunct10500 near a distal end of the jaw 34. Assuming the adjunct 10500possesses an in-plane area that is approximately the same as the area ofthe tissue contacting surface 33, the third attachment mechanism 10506can be configured to inhibit in-plane movement or deformation of adistal end of the adjunct 10500 proximate to the tissue contactingsurface 33. For example, the third attachment mechanism 10506 can beconfigured to apply a compressive force to a distal-most end of theadjunct 10500 when secured to a distal-most end of the jaw 34.

As illustrated in the embodiment of FIGS. 72 and 74, in one embodiment,the third attachment mechanism 10506 can be a clip that reversiblycouples to the jaw 34 to selectively permit or inhibit separation of thedistal end of the adjunct 10500 from the distal-most end of the tissuecontacting surface 33. The illustrated clip includes a base 10506 aconnected to an arm 10506 b. The illustrated clip is formed in a “U” orhook shape, with the arm 10506 b overlying the base 10506 a. A socket10510 can be formed in the distal-most end of the jaw 34 and extendslongitudinally inward therefrom and is dimensioned to receive the base10506 a. When the illustrated clip is coupled to the jaw 34, the arm10506 b extends over the adjunct 10500 and can exert the compressiveforce upon distal-most end of the adjunct 10500. This compressive forceprevents the distal end of the adjunct 10500 from separating from thedistal-most end of the tissue contacting surface 33. By varying theseparation of the base 10506 a and the arm 10506 b, and/or an elasticmodulus of the clip, the compressive force can be varied. Alternatively,when the base 10506 a of the clip is removed from the socket 10510, thearm 10506 b of the clip does not extend over the adjunct 10500 and doesnot exert the compressive force upon distal-most end of the adjunct10500, allowing separation of the distal-most end of the adjunct 10500from the tissue contacting surface 33.

The third attachment mechanism 10506 can be configured to decouple fromthe jaw 34 upon ejection of a staple by the firing system. For example,as illustrated in FIGS. 72 and 74, the base 10506 a can be aligned witha path of the knife blade 36. When the firing system is activated, thestaples are ejected from the staple cartridge 40 and the knife blade 36is advanced through the jaw 34. The advancement of the knife blade 36can be sufficient to push the base 10506 a out of the socket 10510,decoupling the third attachment mechanism 10506 from the jaw 34.

The third attachment mechanism 10506 can be further configured tooperate in combination with the second attachment mechanism 10504. Forexample, as illustrated in the embodiment of FIG. 72, at least one post10504 a is formed proximal to the portion of the adjunct 10500 overwhich the arm 10506 b extends and applies the compressive force. Thatis, when the clip is coupled to the jaw 34, the arm 10506 b does notoverlie any of the posts 10504 a. Thus, the posts 10504 a do notinterfere with application of the compressive force to the adjunct 10500by the arm 10506 b. Furthermore, in addition to preventing curling ofthe adjunct 10500 at the distal-most end of the adjunct 10500, thecompressive force exerted by the arm 10506 b upon the adjunct 10500 canalso act to inhibit in-plane sliding or deformation (longitudinally orlaterally) of the distal end of the adjunct 10500.

FIGS. 75 and 76 illustrate another embodiment of a hybrid attachmentmechanism configured for use with the stapler 10 and coupling theadjunct 10500 to a tissue contacting surface of the jaw 32. However, itmay be understood that embodiments of the hybrid attachment mechanismcan be employed with any surgical instrument without limit. Furthermore,embodiments of the hybrid attachment mechanism can be employed to coupleadjuncts with the tissue contacting surface 33 of the upper jaw 34, atissue contacting surface of the jaw 32, and combinations thereof.

The hybrid attachment mechanism can include the first attachmentmechanism 10502, the second attachment mechanism 10504, and a fourthattachment mechanism 10800. As illustrated in FIG. 75, the firstattachment mechanism 10502 is provided in the form of longitudinalstrips adjacent to a slot 10802 that receives the knife 36 and thesecond attachment mechanism 10504 is provided in the form of the posts10504 a and/or 10504 b are arranged along the length of the jaw 32,adjacent the lateral sides.

FIG. 76 illustrates the fourth attachment mechanism 10800 in combinationwith the adjunct 10500. The fourth attachment mechanism 10800 includessutures that encircle a periphery of the jaw 32. For example, twosutures are positioned adjacent to a proximal end 10032 p and a distalend 10032 d of the jaw 32. However, any number of sutures can beprovided and their location can be varied, as necessary. The sutures areconfigured to exert a compressive force upon the adjunct 10500,inhibiting longitudinal and/or lateral sliding of the adjunct 10500 withrespect to the jaw 32, as well as vertical separation of the adjunct10500 with respect to the jaw 32. Thus, by combining the firstattachment mechanism 10502, the second attachment mechanism 10504, andthe fourth attachment mechanism 10800, the hybrid attachment mechanismcan provide improved resistance to out-of-plane deformation, maintainingthe adjunct 10500 is on the tissue contacting surface 10804, as well asimproving resistance to in-plane sliding or deformation.

In further embodiments, the fourth attachment mechanism 10800 can beconfigured to decouple from the jaw 32 to permit the adjunct 10500 toseparate from the jaw 32. For example, the sutures extend laterallyacross the width of the jaw 32, intersecting the slot 10802. When thefiring system is activated, staples are ejected from the staplecartridge 40 and the knife blade 36 is advanced through the jaw 32within the slot 10802. The advancement of the knife blade 36 cuts thesutures, decoupling the third attachment mechanism 10506 from the jaw34.

It may be understood that, while embodiments of the hybrid attachmentmechanism discussed above include the first attachment mechanism 10502,the second attachment mechanism 10504, and the third attachmentmechanism 10506, alternative embodiments of the hybrid attachmentmechanism can include any two of the first attachment mechanism 10502,the second attachment mechanism 10504, the third attachment mechanism10506, and the fourth attachment mechanism 10800. For example, thehybrid attachment mechanism can include the first attachment mechanism10502 and the second attachment mechanism 10504, without the thirdattachment mechanism 10506. Alternatively, the hybrid attachmentmechanism can include the first attachment mechanism 10502 and the thirdattachment mechanism 10506, without the second attachment mechanism10504. Additionally, the hybrid attachment mechanism can include thesecond attachment mechanism 10504 and the third attachment mechanism10506, without the first attachment mechanism 10502. Alternatively, thehybrid attachment mechanism can include the first attachment mechanism10502 and the fourth attachment mechanism 10800.

Systems for Coupling Adjuncts to an End Effector

Adjunct materials can be applied to one or both jaws of an end effectorof a surgical instrument in various ways. For example, an adjunctmaterial can be manually positioned on a jaw. It is desired toreleasably couple an adjunct to a jaw such that the adjunct does notslip off the jaw prior to application of the adjunct to tissue whenstaples are fired. However, some approaches may not result in a secureenough attachment of the adjunct to a jaw. This compromises the abilityof a surgeon to manipulate the surgical instrument with the adjunct asdesired during the surgical procedure.

Accordingly, in some embodiments, systems and methods are provided forapplying an adjunct material to a jaw of an end effector to bereleasably retained thereon. The adjunct material can be coupled to thejaw using an adhesive that can be applied to the adjunct and/or the jawin a controlled manner. In some implementations, the adjunct materialcan be coupled to the jaw via an intermediate polymer layer.

In some embodiments, an adjunct loading member of a loading system canbe used that is configured to releasably hold at least one adjunctmaterial. The adjunct material is configured to be transferred from theadjunct loading member to a jaw of first and second jaws of an endeffector. A supporting member of a suitable configuration is configuredto releasably retain the adjunct material that can be associated withthe supporting member in various ways. For example, the adjunct materialcan be disposed on the supporting member. Additionally or alternatively,the supporting member can be in the form of retaining feature(s)releasably holding the adjunct material in the adjunct loading member.The adjunct loading member also includes an adhesive depot having anadhesive configured to transition from a non-flowable state to aflowable state upon the application of heat when the adjunct material isreleased from the adjunct loading member and transferred to the jaw.Once the adhesive in the flowable state is cooled, it adheres to the jawand is thus used to retain the adjunct material on the jaw.

The adjunct material is configured to be released from the adjunctloading member under application of a load. The adjunct is transferredto the jaw and is caused to adhere to the jaw using the adhesivedisposed in the adhesive depot when the adhesive is in the flowablestate. Heat can be applied to the adhesive prior to or at leastpartially at the time when the adjunct is being released from theadjunct loading member to the jaw. The load can be applied by the jawsof the end effector when the adjunct loading member is clampedtherebetween. Alternatively, the load can be applied to the adjunctloading member manually or in other ways. The application of at leastone of load and heat causes the adhesive from the adhesive depot to beused to retain the adjunct material on the jaw of the end effector.

FIG. 77 illustrates an example of a portion an end effector 11100configured to releasably retain an adjunct material on one or both ofits first and second opposed jaws configured to clamp tissuetherebetween, in accordance with the described techniques. The endeffector 11100, partially illustrated in FIG. 77, has a first jaw havinga cartridge body or cartridge 11102 and a second jaw having an anvil(not shown), with the first and second jaws being configured to clamptissue therebetween. The cartridge body 11102 is configured toreleasably retain thereon an implantable adjunct material 11106. The endeffector 11100 can be coupled to a distal end of a shaft of the surgicalinstrument (not shown). The end effector 11100 can be used in anysuitable surgical instrument, for example, a linear surgical stapler(e.g., stapler 10 in FIG. 1, stapler 50 in FIG. 4, or any other surgicalstapler, including a circular stapler, such as stapler 80 in FIG. 5)which can be suitable for use with at least one adjunct.

As shown in FIG. 77, the cartridge body 11102 has a plurality of stapleor staple-holding cavities 11108 configured to seat staples therein, thestaple-holding cavities 11108 opening on a tissue-facing surface 11110of the cartridge 11102. The staple cavities 11108 form a certain patternon the surface of the cartridge 11102 which corresponds to a pattern ofstaple-forming cavities formed in the anvil (not shown). The cartridge11102 includes a cutting element or knife channel 11113 extendingbetween distal and proximal ends 11102 d, 11102 p of the cartridge11102. The knife channel 11113 is configured to receive a cuttingelement (e.g., a knife) as it moves distally therethrough. As shown inFIG. 77, the staple cavities 11108 can form three rows on both sides ofthe cutting element channel 11113, though it should be appreciated thatthe staple cavities 11108 can form any other patterns on thetissue-facing surface 11110.

The cartridge body 11102 can be in the form of a staple channelconfigured to support a staple cartridge, which can be removably andreplaceably seated within the staple channel. Furthermore, in someembodiments, the cartridge 11102 can be part of a disposable loadingunit coupled distally to a shaft of a surgical instrument.

In this example, the end effector 11100 is configured to releasablyretain thereon the implantable adjunct material (or “adjunct”) 11106. Inthe illustrated implementation, the adjunct material 11106 releasablyretained on the cartridge 11102 is discussed, though it should beappreciated that the anvil can also have an adjunct material releasablyretained thereon. The adjunct material 11106 can be applied to thecartridge 11102 using a loading member of a loading system, such as anadjunct loading member 11200 shown in FIG. 79 and discussed in detailbelow.

Regardless of the configuration of the loading member, the adjunctmaterial 11106 is configured to be transferred from the loading memberto the cartridge 11102 using an adhesive depot having an adhesiveconfigured to transition from a non-flowable state to a flowable stateupon the application of heat when the adjunct material is released fromthe adjunct loading member and transferred to the jaw to retain theadjunct material on the jaw. The adhesive depot can have a variety ofconfigurations and it can be configured to allow the adhesive to bereleased therefrom in a variety of ways. In this example, as shown inFIG. 77, the adhesive depot is in the form of protrusions formed on apolymer attachment layer or polymer layer 11112 disposed on a jaw-facingsurface of the adjunct material 11106, as also shown schematically inFIG. 78. In particular, the polymer layer 11112, shown in FIG. 77 withits jaw-facing surface 11115 facing up for the illustration purposesonly, has a plurality of protrusions 11114 including or formed from anadhesive. In FIG. 77, the polymer layer 11112 has two shorterprotrusions (collectively referred to as 11114 a, 11114 b) at each ofdistal and proximal ends 11112 d, 11112 p thereof, respectively, and twolonger protrusions 11114 c disposed between the protrusions 11114 a,11114 b. The pairs of protrusions 11114 a, 11114 b, 11114 c are formedalong a longitudinal axis 11A2 of the polymer layer 11112, andsymmetrically with respect to a centerline of the polymer layer 11112.

As shown in FIG. 77, the tissue-facing surface 11110 of the cartridge11102 can include attachment features 11116 configured to engage theprotrusions 11114. In particular, the adhesive included in theprotrusions 11114 or from which the protrusions 11114 are formed can bedisposed on the attachment features 11116. The attachment features 11116can have various configurations. For example, they can be formed asrecesses in the cartridge 11102. Additionally or alternatively, theattachment features 11116 can include a roughness pattern, which can beformed in any suitable manner. The roughness pattern can have anysuitable texture. For example, in one embodiment, the attachmentfeatures 11116 can be formed by making grooves having a pattern ofmultiple “Xs” (or other shapes or features) on the surface of the jaw.In this example, the cartridge 11102 is shown to have six attachmentfeatures formed at the distal and proximal ends 11102 d, 11102 pthereof, symmetrically with respect to the channel 11113. It should beappreciated however that a cartridge of an end effector can include anyother number of the attachment features (e.g., less then eight orgreater than eight).

The protrusions 11114 formed on the polymer layer 11112 and theattachment features 11116 formed on (or in) the cartridge 11102 can havevarious shapes, including different shapes. For example, they can begenerally elongate and rectangular, as shown in FIG. 77. Additionally oralternatively, they can be square, semi-circular (e.g., having asemi-circular or oval shape as viewed from the top), and/or they canhave any other suitable regular or irregular shapes.

In some embodiments, at least one protrusion can be formed at a locationon the polymer layer corresponding to a location of an attachmentfeature formed on the jaw. Thus, as shown in FIG. 77, the sixprotrusions 11114 are formed on the polymer layer 11112 at locationsthat correspond to the locations of the six attachment features 11116.The length and width of the protrusions 11114 can be different fromthose of the attachment features 11116. In addition, in some cases, oneprotrusion can be disposed over more than one attachment feature, andvise versa. Thus, the protrusions formed on the polymer layer and theattachment features formed on the jaw can form various patterns and cancorrespond to one another in various manners.

Regardless of the specific number, size, and locations of adhesiveprotrusions formed on the polymer layer 11112, the polymer layer 11112is used to attach the adjunct material 11106 to the cartridge 11102. Thesurface of the polymer layer 11112 that is opposed to the surface 11115on which the protrusions 11114 are formed can be coupled to the adjunctmaterial 11106 in various ways. For example, at least a portion of thepolymer layer 11112 can be formed from a pressure-sensitive adhesivesuch that the adjunct material 11106 can be coupled with the polymerlayer 11112 that is, in turn, coupled with the jaw.

In some embodiments, as shown in FIG. 77, the end effector 11100 caninclude an additional polymer layer 11118 shown in the form of twoportions. The additional polymer layer 11118 can be disposed between theadjunct material 11106 and the polymer layer 11112 or between thepolymer layer 11112 and the cartridge 11102. The additional polymerlayer 11118 can be formed from an adhesive configured to transition froma non-flowable state to a flowable state upon the application of heat.Thus, when the additional polymer layer 11118 is configured to bedisposed between the polymer layer 11112 and the cartridge 11102, it iseffectively additionally used to couple the adjunct material 11106 tothe jaw 11102. It should be appreciated however that the additionalpolymer layer 11118 is optional and may not be present.

The adjunct material 11106 can be formed from any suitable material or acombination of materials, which are discussed above. In someembodiments, the adjunct material 11106 can have a thickness of fromabout 0.006 inches to about 0.008 inches. In some embodiments, theadjunct material 11106 can have a thickness of from about 0.004 inchesto about 0.0160 inches. The polymer layer can have a thickness of fromabout 0.002 inches to about 0.025 inches, and projections 11116 d, 11116p can have a height or thickness of from about 0.005 inches to about0.025 inches.

As mentioned above, in the described embodiments, the adjunct materialis configured to be transferred from an adjunct loading member to a jawof an end effector. FIGS. 79 and 80 show an example of an adjunctloading member 11200 of a loading system that is configured to releasethe adjunct material to retain the adjunct material in the jaw, using atleast one of heat and load (force). FIG. 79 shows a top view of theadjunct loading member 11200, whereas FIG. 80 shows a cross-sectionalview of the adjunct loading member 11200 when it is disposed on a jaw11202 of an end effector.

As in the illustrated example, the adjunct loading member 11200 can bethe form of a generally rectangular frame-like holder configured toreleasably couple one or more adjuncts to one or both jaws of the endeffector (not shown in FIGS. 79 and 80). In the illustrated example, theadjunct loading member 11200 is in the form of a first (e.g., top) andsecond (e.g., bottom) generally rectangular housings 11204, 11205coupled to one another e.g., via a coupling member. In this example, theadjunct loading member 11200 can be used to apply a single adjunct to ajaw. It should be appreciated however, that, in some embodiments, aloader like the adjunct loading member 11200 or a similar loader, can beused to apply a respective adjunct to each jaw of an end effector.

As shown in FIG. 79, the adjunct loading member 11200 includes at leastone heating component 11208 configured to be activated to apply heat toan adhesive depot having an adhesive configured to transition from anon-flowable state to adhering flowable state upon the application ofheat. In this example, as shown in FIG. 80, the adjunct loading member11200 can retain thereon an adjunct material 11206 and a polymer layer11212 having protrusions 11214. The adjunct material 11206 and thepolymer layer 11212 can be similar, for example, to the adjunct material11106 and the polymer layer 11112, though any suitable number of theprotrusions 11214 can be formed on the polymer layer 11212.

As shown in FIG. 79, the adjunct material 11206 can be releasablyretained on a supporting member 11220 that can be configured in anysuitable manner so as to retain the adjunct material 11206. Thesupporting member 11220 that can have or can be in the form of, forexample, retaining features (not shown) configured to releasably holdthe adjunct material 11206. The adjunct material 11206 can be disposedin any suitable way with respect to the supporting member. For example,in some embodiments, the supporting member 11220 can be in the form offeatures formed on one or more sides of the adjunct material 11206. Inthis way, when load is applied to the adjunct loading member 11200, thesupporting member 11220 is caused to release the adjunct material 11206therefrom, thus causing the adjunct material to be transferred to a jawof an end effector. FIG. 80 illustrates by way of example a jaw of anend effector in the form of a cartridge 11202 that has the adjunctloading member 11200 associated wherewith. The cartridge 11202 is shownin FIG. 80 to have the adjunct material 11206 transferred thereto andcoupled thereto using the polymer layer 11212. It should be appreciatedthat, although not shown in FIG. 80, in use, the load is applied to theadjunct loading member 11200 by a first jaw having an anvil and thesecond jaw having cartridge 11202 that are clamped together with theadjunct loading member 11200 disposed therebetween.

In the described embodiments, the adjunct material 11206 is transferredfrom the adjunct loading member 11200 to the cartridge 11202 underapplication of load and the adjunct material 11206 is caused to beretained on the cartridge 11202 using an adhesive that is caused totransition to a flowable state under application of heat. Thus, in use,the adjunct loading member 11200 releasably holding the adjunct material11206 is positioned between the jaws of the end effector (only thecartridge 11202 of the end effector is shown in FIG. 80). To transferthe adjunct material 11206 from the adjunct loading member 11200 to thejaw 11202, the first and second jaws are approximated to thereby applyload to the adjunct loading member 11202, which causes the adjunctmaterial 11206 to be released from the adjunct loading member 11200. Theadjunct loading member 11200 can be configured such that it exposes theside of the polymer layer 11212 (having the adjunct 11206 coupledthereto) having the protrusions 11214. The application of load can causethe supporting member 11220 and, in some implementations, other portionsor features of the adjunct loading member 11200 to crack, break, deform(e.g., bend, flex, etc.) or otherwise change their configuration tothereby release the adjunct 11206 from the adjunct loading member 11200.In some embodiments, the housings 11204, 11205 of the adjunct loadingmember 11200 can be configured to deform or break to release the adjunct11206 from the adjunct loading member 11200 when the adjunct loadingmember 11200 is clamped between the jaws 11200 (and not shown) of theend effector such that the load is applied thereto. As such, the adjunct11206 can be “squeezed out” of the adjunct loading member 11200. Theadjunct loading member 11200 can be disposable such that it can bediscarded after the adjunct 11206 (and the polymer layer 11212 coupledthereto) is transferred to the jaw.

Heat is applied to at least a portion of an adhesive depot such as theprotrusions 11214 of the polymer layer 11212 having an adhesive anddisposed in the adjunct loading member 11200 in association with theadjunct material 11206, which causes the adhesive to transition from anon-flowable state to adhering flowable state when the adjunct material11206 is released from the adjunct loading member 11200 and transferredto the jaw 11202. For example, under the application of heat, theadhesive from which the protrusions 11214 are formed can transition froma substantially non-liquid state (in which it is in the non-flowablestate) to at least partially liquid state (in which the adhesive is inthe flowable state). In the at least partially liquid state, theprotrusions 11214 can become less viscous such that their material canflow and interconnect or adhere with the surface of the cartridge 11202.The cartridge 11202 can have attachment features (e.g., similar to theattachment features 11116 in FIG. 77) that can have the protrusions11214 in the flowable state disposed thereon such that the protrusions11214 on the polymer layer 11212 adhere to the surface of the cartridge11202. Because the polymer layer 11212 is coupled to the adjunctmaterial 11206, adhering the polymer layer's protrusions 11214 to thecartridge 11202 causes the adjunct material 11206 to be releasablyretained on the jaw 11202. When the material from which the protrusions11214 are formed is cooled and thus transitions to the flowable state,the protrusions 11214 remain attached to the cartridge 11202.

In some embodiments, the adjunct loading member 11200 can be activated(e.g., using a button, switch, or other suitable trigger on the member11200 or a remote trigger), to apply heat to the polymer layer 11212before (or as) the load is applied to the adjunct loading member 11200.For example, the heating component 11208 can be activated before theadjunct loading member 11200 is positioned between the jaws of the endeffector. The adjunct loading member 11200 can be configured to deliverto the polymer layer 11212 heat of a desired temperature (e.g., in arange of from about 105° C. to about 220° C.) for an appropriateduration of time (e.g., from about 5 seconds to about 60 seconds) suchthat the application of heat causes the protrusions 11214 of the polymerlayer 11212 to transition from the non-flowable state to the flowable,deformable state. In some embodiments, an indicator configured toindicate that the adhesive has been sufficiently heated to thedeformable state can be activated. This can be, for example, a lightindicator, an audio indicator, etc.

Once the protrusions 11214 are in the flowable state, the adjunctloading member 11200 can be disposed between the approximated jaws thatcause the protrusions 11214, and thus the adjunct 11206 coupled thereto,to attach to the jaw 11202. Furthermore, in some embodiments, heat canbe applied once the adjunct loading member 11200 is disposed between thejaws but prior to the jaws applying the load to the adjunct loadingmember 11200. As another variation, the adjunct loading member 11200 canbe activated to apply heat to at least a portion of the polymer layer11212 and adjunct 11206 at least partially simultaneously with the loadbeing applied to the adjunct loading member 11200.

Regardless of the specific timing of the application of load and heat tothe adjunct 11206 and polymer layer 11212, the adhesive of theprotrusions 11214 is caused to transition to the flowable state in whichthe protrusions 11214 attach to the jaw 11202 thus causing, after theheat is no longer applied, the polymer layer 11212 to be attached to thejaw. The application of at least one of the load and heat can also causethe adjunct 11206 to couple to the polymer layer 11212.

The heating component 11208 can have various configurations. Forexample, as shown in FIG. 79, the heating component 11208 includes aresistive heating element 11224 in the form of a wire, which isconnected to a power source 11216. In the illustrated example, as shown,the heating element 11224 includes higher resistance portions 11218along its length. The locations of the higher resistance portions 11218can correspond to regions on the polymer layer to which heat is desiredto be applied, e.g. regions having the protrusions 11114 (FIG. 77).Thus, power can be applied to the heating element 11224 to causelocalized heating near the higher resistance portions 11218. In thisway, the heat is applied selectively to the polymer layer and to theadjunct material coupled thereto.

In some embodiments the heating element 11224 can include a switch 11230configured to close the circuit and to allow current to flow through theheating element. The switch 11230 can be operated using a suitabletrigger associated with the adjunct loading member 11200 (e.g., a buttonor other switch on the loader 11200 activated by closure of the endeffector or by the person loading the device or a remote control),though the heating element 11224 can be activated in other suitableways. The heat generated by the higher resistance portions 11218 causesthe adhesive portions of the polymer layer, such as the protrusions, totransition to the flowable state and thus couple the polymer layer andthe adjunct coupled thereto to the jaw when the polymer layer andadjunct are transferred to the jaw.

The heating component 11208 can be of any suitable type. For example,the heating component 11208 can be made of a rigid material, e.g.,ceramic, that is coated with an elastic or compliant material. In someembodiments, the heating component 11208 can be in the form of aresistive wire embedded into silicone, e.g., such that the silicone iscured around the resistive wire. The resistive wire is configured toeffect the heating, whereas the silicone allows for some degree ofcompliance when clamping a stapler onto the loader. The heatingcomponent 11208 can be coupled to the housings 11204, 11205 in anysuitable manner, e.g., via brackets.

As mentioned above, the adjunct loading member 11200 is generally beconfigured such that the adjunct 11206 is releasably retained inassociation therewith adjunct loading member 11200 using a supportingmember 11220. The supporting member 11220 can be in the form of asurface and/or it can include retaining features that can releasablycouple the adjunct 11206 and the polymer layer 11212 to the adjunctloading member 11200. The adjunct 11206 can be disposed on the heatingcomponent 11208, as shown schematically by way of example only in FIG.80. In this way, once the heating component 11208 is activated, heat isapplied to the adjunct 11206 and the polymer layer 11212 that faces thejaw 11202.

In some embodiments, an adjunct loading member, which can be similar tothe adjunct loading member 11200 can be configured to releasably retainfirst and second adjuncts, each configured to be transferred to arespective one of first and second jaws of an end effector. The adjunctscan be secured to both jaws of the end effector simultaneously. Aheating component can be configured to apply heat to polymer layer'sprotrusions or other adhesive depots associated with the adjuncts toretain the adjuncts on the respective jaws. Furthermore, in someembodiments, the heating component can be in the form of two heatingcomponents disposed in the removable loader such that each of theheating components is configured to apply heat to a different adjunctthat can be associated therewith (e.g., via the loader or manually).

After the adjunct 11206 is coupled to the jaw 11202 and the heat is nolonger applied thereto, the adhesive from which the protrusions 11214are formed can at least partially return to the original state, althoughnot to the original shape. This can occur because the heat source isremoved (i.e. the adjunct loading member 11200 is removed, or the powerto the heaters is switched off after a set time) and the adhesive isexposed to a room temperature. This can be done while the polymer layer11212 remains at least partially associated with the adjunct loadingmember 11200. Also, the adjunct loading member 11200 can be part of aloading system including other components, and such loading system canbe configured to cool the adhesive coupling the polymer layer 11212 tothe jaw. For example, a cool air can be applied to the polymer layer11212 coupled to the adjunct 11206. In some embodiments, the cooling canbe done using a separate component.

In some embodiments, a trigger associated with the loader (e.g., aswitch) is configured to be activated to turn on the heating componentsonce the end effector is clamped onto the loader. This causes theresistors to be heated which thus cause the polymer layer to be heated.The compression or load from the end effector causes the adhesive toflow and conform to the features on the jaw. The power to the resistorscan automatically cease after a preset time (either a timer in thecircuit, or the circuit can self-destruct with time/heat, or the batterycan expire, etc.). After the heat is no longer applied, the polymeradhesive will cool, e.g., due to the thermal mass of the jaws. Theloader, or other suitable component, can be configured to, after a timesufficient for the adhesive to cool and thus transition to an adheredstate has passed, provide an indication indicating that the process ofadhering the adhesive (and thus coupling the adjunct to the jaw) hasbeen completed. The indication can be provided in any suitable way—forexample, it can be a visual (e.g., light) indicator, audio indicator,any combination of a visual/audio indicator, etc.

Regardless of the manner in which the adhesive coupling the polymerlayer 11212 to the jaw 11202 is cooled, the adhesive at least partiallyhardens or solidifies. The adjunct 11206 is coupled to the jaw 11202 viathe polymer layer 11212 with the protrusions 11214 in a releasablemanner and can thus be separated from the jaw 11202. For example, whenstaples are fired from the jaw 11202, the bond between the adhesive andthe jaw 11202 can break or crack.

The polymer layer 11212 and the protrusions 11214 formed thereon can bemade from any suitable material or a combination of materials. Also,they can be bioabsorbable and/or biodegradable. The protrusions 11214can be formed from a material having a lower melting point than amelting point of a material from which the polymer layer 11212 is made.For example, if the material from which the protrusions 11214 are madeis PDO, its melting point can be less than about 105° C. However,materials with a melting point that is less than about 180° C. can beused additionally or alternatively. When heat is applied to the polymerlayer 11212 (e.g., selectively, such that portion(s) of the protrusionsare exposed to heat), the adhesive of the protrusions 11214 can betransitioned to a flowable state, whereas the state of an adhesive fromwhich the polymer layer 11212 is made does not change.

In some embodiments, an adhesive depot having an adhesive configured totransition from a non-flowable state to a flowable state upon theapplication of heat is in the form of a plurality of reservoirs. Theplurality of reservoirs can be formed in a supporting layer of anadjunct loading member and each can releasably hold the adhesive.

FIGS. 81A and 81B illustrate an embodiment of an adjunct loading member11400 releasably holding first and second adjunct materials 11306, 11316on first and second supporting members 11420, 11422, respectively. Theadjunct loading member 11400 is used to transfer the first and secondadjunct materials 11306, 11316 to first and second jaws 11302, 11304 ofan end effector 11300, as discussed below. In this example, the firstjaw 11302 has a cartridge (which can be removably and replaceably seatedin the jaw or which can be part of a reloadable unit including the firstjaw 11302 or both the first and second jaws 11302, 11304), and thesecond jaw 11304 has an anvil.

In the illustrated embodiment, the adjunct loading member 11400 is inthe form of a generally rectangular member having first and secondgenerally rectangular housings 11402, 11404 coupled to one another. Asshown, the adjunct loading member 11400 includes an adjunct holdingmember 11406 extending between the housings 11402, 11404 and includingvarious components. In particular, the adjunct holding member 11406includes body members 11416 a, 11416 b shown in the left and right sidesof the adjunct loading member 11400, respectively, brackets 11410 a,11412 a at one side of the adjunct loading member 11400 (left in FIGS.81A and 81B), brackets 11410 b, 11412 b at another side of the adjunctloading member 11400 (right in FIGS. 81A and 81B), and the first andsecond supporting members 11420, 11422 extending between the bodymembers 11416 a, 11416 b.

The supporting members 11420, 11422 are disposed in the adjunct loadingmember 11400 such that their mid-portions having the first and secondadjunct materials 11306, 11316 releasably retained thereon are notencompassed by the housings 11402, 11404. The brackets 11410 a, 11410 bextend over the body members 11416 a, 11416 b at one side thereof(bottom in FIGS. 81A and 81B) and retain the first adjunct 11306 overthe supporting member 11420. In a similar manner, the brackets 11412 a,11412 b extend over the body members 11416 a, 11416 b at another,opposed side thereof (top in FIGS. 81A and 81B) and retain the secondadjunct 11316 over the supporting member 11422.

As shown, each of the brackets has a straight portion (e.g., a portion11411 of the bracket 11410 a) extending along and over one of the bodymembers 11416 a, 11416 b, and a trapezoid-shaped deformable portion(e.g., a portion 11413 of the bracket 11410 a) extending from thestraight portion towards a center of the adjunct loading member 11400.One end of each of the trapezoid-shaped deformable portion of thebrackets 11410 a, 11410 b, and 11412 a, 11412 a is disposed over thefirst and second adjunct materials 11306, 11316, respectively. It shouldbe appreciated that the brackets are shown to have the trapezoid-shapeddeformable portion by way of example only, as the brackets can have anyother configuration.

In the illustrated embodiments, the adhesive depots are in the form ofreservoirs formed in the supporting members. Thus, as shown in FIG. 81A,the supporting member 11420 has reservoirs 11424 a, 11424 b, and thesupporting member 11422 has reservoirs 11426 a, 11426 b. Each of thereservoirs 11424 a, 11424 b, 11426 a, 11426 b releasably holds anadhesive and includes an opening through which the adhesive can bereleased from that reservoir. For example, in FIG. 10, the reservoir11426 a is shown to have an opening 11430 a, and other reservoirs havesimilar openings. As also shown, each of the adjunct materials 11306,11316 includes a plurality of openings each having a reservoir withadhesive associated therewith. In particular, the adjunct material 11306has openings 11310 a, 11310 b disposed adjacent to the openings in thereservoirs 11424 a, 11424 b. Similarly, the adjunct material 11316 hasopenings 11312 a, 11312 b disposed adjacent to the openings in thereservoirs 11426 a, 11426 b. It should be appreciated, however, that insome embodiments, the reservoirs can be configured differently—e.g.,they may not have openings, but can have a breakable, meltable, orotherwise removable enclosure that allows to retain the adhesive in thereservoirs and that can be removed when it is desired to release theadhesive. Additionally or alternatively, openings configured to allow anadhesive to flow from the reservoir can be formed in the supportingmember.

The openings, such as the openings 11310 a, 11310 b in the adjunctmaterial 11306 and the openings 11312 a, 11312 b in the adjunct material11316, are formed at locations in the adjuncts at which it is desired toform attachment portions or points (made of an adhesive) that couple theadjuncts to the jaw. The opening locations in each of the adjuncts canbe selected so as to facilitate attachment of the adjunct to the jaw andto also facilitate release of the adjunct from the jaw. It should beappreciated that the adjuncts 11306, 11316, which are shown in FIGS. 81Aand 81B in cross-section, can include more than two openings. Multipleopenings can be formed so as to attach the adjunct to the jaw using anadhesive at more than two locations. For example, four, six, eight, ormore openings can be formed in each of the adjuncts. Also, although, asin the example in FIGS. 81A and 81B, the openings can be formed in pairs(e.g., they can be disposed symmetrically along a centerline of theadjunct), an odd number (e.g., three, five, etc.) of openings can beformed, which corresponds to an odd number of attachment points to beformed when the adjunct is coupled to the jaw.

The adjunct loading member 11400 has first and second heating components11408, 11418 extending through the supporting members 11420, 11422 thatare configured to apply heat to the adhesive held in the reservoirs11424 a, 11424 b and 11426 a, 11426 b, respectively, to cause theadhesive to transition from a non-flowable state to a flowable state. Insome implementations, a single heating component can be used. Also, thefirst and second heating components 11408, 11418 can be parts of thesame heating component. The openings 11310 a, 11310 b, 11312 a, 11312 bare configured to receive the adhesive transitioning to the flowablestate when the adhesive material is released from a respective one ofthe reservoirs and through the opening to a jaw-facing surface of therespective adjunct material to thereby retain that adjunct material onthe jaw.

In use, the adjunct loading member 11400 having the adjunct materials11306, 11316 releasably retained thereon is disposed between the firstand second jaws 11302, 11304 of the end effector 11300, as shown in FIG.81A that illustrates the adjunct loading member 11400 before a load isapplied thereto. The load is then applied to the adjunct loading member11400 by the first and second jaws 11302, 11304 that clamp the adjunctloading member 11400 therebetween, as shown in FIG. 81B. Under theapplication of load exerted by the jaws, the adjunct loading member11400 is at least partially deformed, which causes the adjunct materials11306, 11316 to be transferred to the jaws 11306, 11316, respectively.For example, the brackets 11410 a, 11410 b, and the brackets 11412 a,11412 a can be at least partially deformed. Also, the supporting members11420, 11422, which can be formed from a silicone or other deformableand resilient material(s), are deformed under the load, as shown in FIG.81B. When load is applied to the adjunct loading member 11400, thesupporting members 11420, 11422 apply pressure to the adjunct materials11306, 11316, which can be done in the manner that facilitates uniformapplication of the load to the adjunct materials. This helps apply theadjunct to the jaws in a uniform manner.

In the illustrated example, the adjunct loading member 11400 isconfigured so that the adjunct materials 11306, 11316 are transferredsubstantially simultaneously to the jaws 11306, 11316. It should beappreciated, however, that in some embodiments the adjunct loadingmember can be configured to transfer one adjunct to an end effector'sjaw.

Before or at the time when the load is applied to the adjunct loadingmember 11400, the heating components 11408, 11418 are activated to causeheat to be applied to the reservoirs 11424 a, 11424 b and 11426 a, 11426b, respectively, to cause the adhesive in the reservoirs to transitionfrom the non-flowable state to the flowable state. The adhesive can bestored in the reservoirs 11424 a, 11424 b, 11426 a, 11426 b in asubstantially non-liquid state, and, under the application of heat, theadhesive can become at least partially liquid such that it can be usedto couple the adjunct materials to the jaws. As shown in FIG. 81B, whenthe load is applied, the adhesive is released from the reservoirs,through the openings in the adjuncts 11306, 11316, and onto the surfaceof the jaws 11302, 11304. In this way, the portions of adhesive 11427 a,11427 b and 11429 a, 11429 b released from the reservoirs 11424 a, 11424b and 11426 a, 11426 b, respectively, are used to retain the adjunctmaterials on the opposed jaws of the end effector 11300.

The reservoirs 11424 a, 11424 b, 11426 a, 11426 b can have any suitableconfigurations and they can be configured to release the adhesive storedtherein in various ways. In the illustrated example, they are at leastpartially enclosed structures that store the adhesive. For example, theycan be formed from a rigid plastic having a liquid adhesive (e.g., apressure-sensitive adhesive) stored therein. As mentioned above, thereservoirs can have openings formed on the side thereof adjacent to theadjunct.

Furthermore, in some embodiments, the adjunct loading member 11400 caninclude a closure component that can be disposed so as to temporarilyenclose one side of the reservoirs and thereby retain the adhesivetherein. With reference to FIG. 81A, such a closure component can bedisposed between each of the supporting layers and a respective adjunctmaterial. The closure (or a cap) can be a removable component that isremoved to allow the adhesive to flow from the reservoirs. As anothervariation, the closure component can be in a form of component that canbe disposed in at least two different ways with respect to thereservoirs. In particular, the closure component can have openings thatcan align with the openings in the reservoirs. However, before theadhesive is released from the reservoirs, the closure component can bedisposed such that the openings therein are not aligned with theopenings in the reservoirs and the closure is thus blocking the openingsin the reservoirs and prevents release of the adhesive therefrom. Theclosure component can be, for example, slidable such that it can bemoved to configuration in which its openings are aligned with theopenings in the reservoirs. In some embodiments, the closure componentcan be in the form of a membrane or other thin member configured torupture when pressure applied thereto exceeds a threshold.

The adjunct loading member 11400 is configured such that it can beseparated from the end effector 11300 after the adjuncts 11306, 11316are transferred to the jaws 11302, 11304 and are retained on the jawsusing the adhesive. The adhesive can solidify and thus securely retaineach adjunct on the jaw. In some embodiments, as discussed above, theadhesive can be allowed to solidify at a room temperature. Additionallyor alternatively, it can be actively cooled using, e.g., a forced coolair.

The adhesive releasably retained in the reservoirs can be any suitablematerial. For example, it can be a flowable material such aspolydioxanone (PDO), a high molecular weight poly(ethylene glycol)(PEG), or any other material. As mentioned above, the adhesive can be apressure-sensitive adhesive.

Although in the illustrated embodiments heat is applied to an adhesiveusing an adjunct loading member, it should be appreciated that the heatcan be applied in other manners. For example, in some implementations,an end effector can be configured to apply heat to the adhesive whichcan be releasably held in any type of an adhesive depot (e.g., a polymerlayer having adhesive features, reservoirs in an adjunct loading member,etc.). The end effector can include a wire or other component that canbe heated and can thus apply heat to the adhesive which thereby softensand can retain an adjunct on a jaw. In some embodiments, a separateheating component can be applied, which is not part of an end effector.

At least one adjunct can be applied to one or both jaws of the endeffector during assembly of the end effector. For example, a jaw havinga cartridge or both of the end effector's jaws can be pre-loaded with anadjunct during the assembly. In some cases, the jaw with the cartridgecan be pre-loaded with an adjunct during the assembly, whereas anadjunct can be applied to the jaw having an anvil (e.g., using any ofthe adjunct loading members described herein) by a surgeon before orduring a surgical procedure. Alternatively, as in the embodimentsillustrated in FIGS. 81A and 81B, adjuncts can be applied to both jawsof the end effector by a surgeon (this however can be done duringassembly as well).

A configuration of an adjunct loading member can vary in different ways.FIG. 82 illustrates an example of an adjunct loading member 11500 whichcan be similar to adjunct loading member 11400 in FIGS. 81A and 81B.Thus, as shown in FIG. 82, the adjunct loading member 11500 includeshousings 11502, 11504 coupled to one another. The adjunct loading member11500 also includes supporting members 11520, 11522 disposed in theloading member 11500 such that the housing 11502, 11504 enclose thesupporting members 11520, 11522 along their perimeters. One side of thesupporting members 11520, 11522 is not enclosed, as shown.

The supporting members 11520, 11522 have reservoirs releasably holdingan adhesive, with one of the reservoirs, a reservoir 11524 a, shownformed in the supporting layer 11520. A top of another reservoir 11524 bis also shown formed in the supporting member 11520. One or both of thereservoirs and supporting members in which the reservoirs are formed canhave openings that allow the adhesive stored in the reservoirs to bereleased therefrom. Thus, the reservoir 11524 b is shown to have anopening 11530 above it, which can be formed in either the reservoir11524 b itself or in the supporting member 11520. Also, as discussedabove, a closure component can be used (not shown), and an opening canbe formed in this component as well.

FIG. 82 shows that the adjunct loading member 11500 releasably retainstherein an adjunct material 11506, which is shown partially forillustration purposes. The adjunct material 11506 includes openings11510 that are configured to receive the adhesive transitioning to theflowable state when the adhesive is released from a respective one ofthe reservoirs and through the opening to a jaw-facing surface of therespective adjunct material to thereby retain that adjunct material onthe jaw. The adjunct material 11506 is releasably retained on thesupporting member 11520. It should be appreciated that, although it isobscured in FIG. 82, the loading member 11500 can include a secondadjunct material releasably retained on the supporting member 11522.

The adjunct material 11306 is releasably retained in the adjunct loadingmember 11500 using retainer elements 11512, which can have any suitableconfigurations. Although the retainer elements 11512 on one side of theadjunct material 11306 are shown, it should be appreciated that they canalso be formed on the opposed side of the adjunct material 11306, inwhich case they are obscured in FIG. 82. Also, the retainer elements11512 can be configured such that they can be movable—e.g., when load isapplied to the adjunct loading member 11500, the retainer elements canbe caused to move towards the edges of the housings 11502, 11504, suchthat the retainer elements release the adjunct material 11306.

As shown in FIG. 82, a heating component 11508 coupled to a power source11516 is disposed between the supporting members 11520, 11522. Theheating component 11508, e.g., its higher resistance portions 11532 areused to apply heat to respective reservoirs to cause the adhesive storedin the reservoirs to transition from a non-flowable state to a flowablestate.

Similar to the adjunct loading member 11400 in FIGS. 81A and 81B, theadjunct loading member 11500 is configured to have load applied theretoto cause it to release one or more adjunct materials therefrom which aretransferred to jaw(s) of an end effector and are coupled to the jaw(s)using the adhesive.

In some embodiments, an adhesive depot can include an adhesive that issubstantially liquid in a non-cured state and that is configured to betransitioned to an adhering, cured state in which it is at leastpartially non-liquid. This can involve curing the adhesive, which can bedone using application of ultra violet (UV) light or infrared radiation.Additionally, load (or pressure) applied to the adhesive can facilitatecuring the adhesive in some instances. In the cured, at least partiallynon-liquid state, the adhesive is used to couple an adjunct to a jaw ofan end effector.

FIGS. 83A-83C illustrate an example of a portion of an adjunct loadingmember 11600 including a supporting member 11620 releasably retaining anadjunct material 11606. The supporting member 11620, which can be atleast partially made from a silicone or other compressible material,includes one or more reservoirs holding an adhesive, one of which isshown as a reservoir 11614 storing an adhesive 11616. As shown in FIG.83A, the reservoir 11614 is disposed adjacent to an opening 11610 in theadjunct material 11606. The reservoir 11614 can be an enclosed structure(e.g., formed from a suitable plastic) releasably holding the liquidadhesive 11616. The adhesive 11616 can be any suitable UV-curableadhesive, such as, for example, polyurethane, cyanoacrylate, or anyother adhesive(s).

The adjunct material 11606 is configured to be transferred to a jaw11602 of an end effector which is, in this example, a jaw having ananvil. The anvil 11602 can have a tissue-facing surface 11605 havingstaple-forming cavities or pockets 11607. Also, as shown in FIGS.83A-83C, the tissue-facing surface 11605 has attachment portions, one ofwhich is shown as an attachment portion 11612 that is configured toreceive the adhesive released from the reservoir 11614. The attachmentportions can be formed between the staple-forming pockets 11607, thoughthey can be formed in other areas of the tissue-facing surface 11605. Insome embodiments, as shown in this example, the attachment portion 11612can include an attachment feature 11613 made from an elastomericmaterial (e.g., a pad) that is coupled to the tissue-facing surface11605. This feature can be patterned (e.g., knurled or otherwiseroughened), which facilitates adherence of the adhesive to this portion.Also, the elastomeric material allows the attachment feature 11613 to bedeformed when the bond between the attachment portion 11612 on thesurface 11605 and the adhesive coupled thereto (which retains an adjunctover the surface 11605) is broken, as discussed in more detail in theexample shown in FIGS. 86A-86C below.

As shown, the adjunct loading member 11600 also includes UV lightapplicators 11603 configured to apply UV light to the adhesive as it isreleased from the adhesive reservoirs. The UV light applicators 11603are coupled to a cable 11611 (e.g., a fiber optic cable) that couplesthe applicators to a UV light source. Also, in some embodiments, the UVlight applicators 11603 can be associated with UV-emitting lightemitting diodes (LEDs).

FIG. 83A illustrates the adjunct loading member 11600 before load isapplied thereto. When the load so applied to the adjunct loading member11600 (e.g., using the jaws of the end effector, manually, etc.), thereservoir 11614 is deformed, broken, or its configuration is otherwisechanged such that the adhesive 11616 is transferred from the reservoir11614, through the opening 11610 in the adjunct 11606, and onto thesurface of the jaw 11302, as shown in FIG. 83B. The adhesive 11616 istransferred to the tissue-facing surface 11605 of the jaw 11302 so as tobe disposed on the surface of the attachment portion 11612. As theadhesive 11616 is being released, the UV light applicators 11603 areactivated to apply UV light to the adhesive 11616 to cause it to cure,as illustrated in FIG. 83C. In this way, the adhesive 11616 is depositedon the surface of the jaw in the adhering, non-cured state (or onlypartially cured) in which it is then cured and thus attaches the adjunct11606 to the jaw 11602. The adjunct loading member 11600 can then beseparated from the end effector.

It should be appreciated that the portion of the adjunct loading member11600 is shown in FIGS. 83A-83C by way of example only. Also, theadjunct loading member 11600 can include multiple reservoirs with theadhesive, more than one openings can be formed in the adjunct, as wellas other variations are possible.

FIGS. 84A and 84B illustrate another example of an adjunct loadingmember 11700 configured to releasably hold first and second adjunctmaterials 11806, 11816 and to apply these adjunct materials to first andsecond jaws 11802, 11804 of an end effector 11800. Similar to adjunctloading member 11600 in FIGS. 83A-83C, a substantially liquid adhesivereleased from the adjunct loading member 11700 is configured to be curedusing UV light, heat, or in other manner. As shown in FIGS. 84A and 84B,the adjunct loading member 11700 is similar to adjunct loading member11400 shown in FIGS. 81A and 81B, and therefore a detailed descriptionis not repeated. However, as mentioned above, the adjunct loading member11700, releasably stores in reservoirs formed in first and secondsupporting members 11720, 11722 an adhesive that is cured upon it isrelease from the reservoirs such that it is used to retain the adjunctson the jaw in its cured state.

Describing by way of example one of the reservoirs included in theadjunct loading member 11700, a reservoir 11824 in the supporting member11720 is configured to provide an adhesive 11827 stored therein whenload is applied to the adjunct loading member 11700 as shown in FIG.84B. A UV light applicator 11808 or other (e.g., infrared radiation)applicator is configured to apply UV or other radiation to the adhesive11827 as it is released from the reservoir 11824. In this way, theadhesive is used to retain the adjunct on the jaw as the adjunct istransferred to the jaw.

Any suitable component can be used to apply radiation to an adhesive tocause it to transition from a state in which it is not cured to anadhering state in which it is cured. FIG. 85 illustrates one embodimentof an adjunct loading member 11900 that can be used to apply radiationto an adjunct material 11906. The adjunct loading member 11900 can begenerally similar to adjunct loading member 11500 in FIG. 82 and istherefore not described in detail. In this example, an adhesive storedin a reservoir, such as a reservoir 11924 formed in a supporting member11920 is configured to be cured when it is released from the reservoir11924 when load is applied to the adjunct loading member 11900 and theadhesive is cured using radiation emitted from a UV applicator 11908.Other types of radiation, however, can be used additionally oralternatively. Similar to the manner described above in connection withthe adjunct loading member 11500 (FIG. 82), the adhesive can be releasedfrom the reservoir and caused to flow through an adjacent opening 11510formed in the adjunct 11906. Although not shown in FIG. 85, the adjunctloading member 11900 can also have a second adjunct material releasablyretained therein and configured to be transferred therefrom and attachedto a second jaw of an end effector similar to the adjunct 11906.

Regardless of the specific way in which an adjunct material is coupledto a jaw of an end effector, it is required to properly separate theadjunct material from the jaw when the adjunct is applied to tissue. Itis desired to release the adjunct from the jaw in an efficient manner.This can be achieved, for example, by fracturing the adhesive thatattaches the adjunct to the end effector. FIG. 86A illustrates anexample of a portion of an adjunct material 111506 attached to the jaw111504 of an end effector 111500 by an adhesive 111514, which can becured in a desirable manner (e.g., using a UV light applied via aloader, or in other manners). The adhesive 111514 releasably attachesthe adjunct material 111506 to the jaw 111504 by being at leastpartially disposed in an opening 111510 formed in the adjunct material111506.

Similar to adhesive 11616 in FIGS. 83A-83C, the adhesive 111514 in FIG.86A is coupled to the jaw 111504 at an attachment region or portion111512 on the surface of the jaw 111504. Similar to attachment portion11612 in FIGS. 83A-83C, the attachment portion 111512 can have adeformable attachment feature 111513 that is patterned to facilitatecoupling the adhesive thereto. The attachment feature 111513 can beformed from an elastomeric material such that it can deform when a forceis applied thereto.

The end effector 111500 can be configured to cause the adjunct material111506 to separate from the jaw 111504 when staples are fired from a jaw111502 having a cartridge that is shown schematically in FIG. 86B. Forexample, as shown, the jaws 111502, 111504 are approximated to clamptissue 111520 therebetween and a stapler driver 111530 movably seated inthe jaw 111502 causes staples 111522 to fire from staple holdingcavities in the jaw 111502 so as to penetrate the tissue 111520 and theadjunct 111506. The staples 111522 are urged into correspondingstaple-forming cavities or pockets 111507 formed on the surface of thejaw 111504 such that the staples 111522 are closed and attach theadjunct 111506 to the tissue 111520.

In the example illustrated, the stapler driver 111530 includesprotruding members 111518 configured to push the cured adhesive 111514towards the attachment portion 111512 and into the attachment feature111513 (which can deform to some degree) when the staples 111522 arefired. This can cause the adhesive 111514 to break, fracture, deform, orotherwise change its configuration. In some instances the cured adhesive111514 can be brittle and applying load thereto causes it to fracture,crack, or break.

It should be appreciated that only portions of the adjunct 111506 andthe end effector 111500 are shown in FIGS. 86A-86C and that multipleattachment portions similar to the attachment portion 111512 (or havingother configurations) can be formed on the jaw 111504 and are used tocouple the adjunct 111506 to the jaw 111504 using the adhesive 111514.Accordingly, multiple corresponding protruding members on the staplerdriver 111530 can cause the adhesive at the corresponding attachmentportions to break. In this way, the adjunct 111502 can be decoupled fromthe attachment region 111512 and thereby be released from the jaw111504. Thus, FIG. 86C illustrates the tissue 111520 and the adjunct111506 stapled together by the staples 111522 and decoupled from the jaw111504 and thus from the end effector 111500. A portion of the adhesive111514, which can be a biodegradable and/or bioabsorbable material, canremain with the adjunct 111506, as shown.

It should be appreciated that the described adjunct materials andsystems and methods used to apply the adjunct materials to at least onejaw of an end effector can have various configurations. For example,although, as discussed above, the adjunct materials can have openingsformed therein that allow an adhesive from an adhesive despot to beapplied to the surface of the adjunct, in some embodiments, the openingsmay not be formed. In such embodiments, the adhesive can be flowed froman adhesive depot (e.g., one or more reservoirs) through pores, spacesbetween fabric strands, or other structures in the adjunct material. Forexample, the adjunct material can be porous and the adhesive are flowtherethrough to a surface of the jaw. The pores can be formed at anysuitable ways, and, in some instances, they can be larger atpredetermined locations through which the adhesive can flow easier.

Adjunct Loader for Surgical Staplers

Various adjunct loaders are provided for cleaning and affixing anadjunct to an end effector of a surgical stapling device. While theadjunct loaders are described in connection with end effectors ofsurgical staplers, the adjunct loaders can be used in connection withany type of surgical device. In an exemplary embodiment, an adjunctloader can be configured to clean at least one tissue-engaging surfaceof an end effector on a surgical stapler, and the adjunct loader can beconfigured to attach an adjunct to the tissue-engaging surface of theend effector. For example, an adjunct loader can have two slots, eachconfigured to seat at least one jaw of the end effector therein. Oneslot can be configured to clean the end effector, and the other slot canbe configured to attach the adjunct to the end effector. The adjunctloader can thus allow a user to rapidly clean and attach an adjunct to asurgical stapler for use during an operation, increasing the speed andconvenience of using adjuncts with a surgical stapler.

Cleaning the end effector and attaching the adjunct can be achievedthrough a variety of techniques. FIGS. 87-89 illustrate one embodimentof an adjunct loader 12100. The illustrated adjunct loader 12100 has aframe 12102, a cleaning slot 12104, and a loading slot 12106. The frame12102 can have any shape, such as a rectangular housing with a topportion 12110 and a bottom portion 12112. The top portion 12110 and thebottom portion 12112 can snap or clip together using, for example, posts12114 that extend from one of the top or bottom portions 12110, 12112and snap into the other of the top or bottom portions 12110, 12112. Inother embodiments, the two portions can be closed together in any numberof ways, such as being glued, sealed, or formed as a single unit.

The frame 12102 can have the cleaning slot 12104 and the loading slot12106 formed therein. The cleaning slot 12104 and the loading slot 12106can be configured to receive at least a portion of an end effector on asurgical stapler. For example, the slots 12104, 12106 can take the formof longitudinal openings formed in the frame 12102 and can be sized andshaped to receive a linear end effector therein, such as the elongatejaws of the surgical staplers 10, 50. The slots 12104, 12106 can extendparallel to each other and can have open ends 12104 a, 12106 a on oneside of the frame 12102 and closed ends 12104 b, 12106 b on an oppositeside of the frame 12102. The closed ends 12104 b, 12106 b can have asemicircular shape, but a variety of different configurations arepossible. The top portion 12110 and the bottom portion 12112 of theframe 12102 can have ledges 12110 a, 12112 a formed along the slots12104, 12106 and configured to create a groove that extends along aperimeter of at least the longitudinal edges of the slots 12104, 12106when the top portion 12110 and the bottom portion 12112 are snappedtogether, as illustrated in FIG. 89.

Each slot 12104, 12106 can be configured to retain a material therein,such as a cleaning material or an adjunct. In the illustratedembodiment, each of the top portion 12110 and the bottom portion 12112of the frame 12102 can have a plurality of fingers 12116 that extendinto the slots 12104, 12106. The fingers 12116 can have a variety ofshapes, such as a wedge shape with a triangular cross-section asillustrated in FIG. 87, and can be configured to retain material betweenthe top portion 12110 and the bottom portion 12112 within the slots12104, 12106. In the cleaning slot 12104, the fingers 12116 can be fixedand configured to remain in place even under a pulling or tugging force.In the loading slot 12106, the fingers can be deflectable and/or springbiased to release material held therebetween under a pulling or tuggingforce. For example, the fingers 12116 in the loading slot 12106 can beconfigured to be retractable into the frame 12102 when jaws of an endeffector clamp onto an adjunct therebetween. In some embodiments, thejaws can push the fingers 12116 into the frame 12102 when engaging theadjunct thereby disengaging the fingers from the adjunct and releasingthe adjunct from the loader 12100.

The cleaning slot 12104 can have a cleaning pad 12120 that extendsbetween the open end 12104 a and the closed end 12104 b of the cleaningslot 12104. The cleaning pad 12120 can have a variety of shapes, such asa rectangular shape. In an exemplary embodiment, the shape correspondsto the shape of an end effector to be cleaned, such as elongate jaws ofa linear surgical stapler. The cleaning pad 12120 can have a tongue12122 that extends from one end of the cleaning pad 12120 and into theopen end 12104 a of the cleaning slot 12104. The cleaning pad 12120 canextend the length between the two ends or can extend some distance lessthan entirely between the two ends, for example as illustrated in FIG.88 in which the cleaning pad 12120 terminates before reaching the closedend 12104 b. The cleaning pad 12120 can extend into the groove formed bythe ledges 12110 a, 12112 a and can be held between the top portion12110 and the bottom portion 12112 of the frame 12102 by the pluralityof fingers 12116. In some embodiments, the fingers can be configured tohold an adjunct in the loading slot 12106 (discussed in more detailbelow) while the cleaning pad 12120 can be configured to be secured tothe frame 12102 through various other techniques. For example, thecleaning pad 12120 can be configured to be secured with holes in the pad12120 that extend over pins in the frame 12102. Other examples caninclude securing the cleaning pad 12120 by the pad 12120 being glued inplace, welded in place, held in place by other posts from the housing12102 that are formed into mushrooms with heated tooling, etc.

The cleaning pad 12120 can have a variety of configurations. Forexample, the cleaning pad 12120 can be made from an abrasive materialwith a cleaning solvent saturated therein and configured to remove avariety of substances, such as adhesive, tissue, and/or oily residue.The cleaning pad 12120 can be configured to remove any build-up and/oradhesive left on jaws (particularly an anvil) on an end effector leftover from any previous firings with an adjunct. This cleaning can bebeneficial to prevent any adhesive build up on the device, which cancause a variety of problems such as causing staples to be malformed,causing over-compression of tissue, etc. In various embodiments, asolution that aids in adhesion can also be added to the cleaning pad12120. The cleaning pad 12120 can be configured to be engaged by opposedjaws on an end effector of a surgical stapler, and it can be configuredto clean one side of the surgical stapler, such as the anvil side or toclean both sides as may be needed. In certain embodiments, the cleaningpad 12120 can have various configurations, such as different sides ofthe pad with a cleaning side and a neutral side, different layers of thepad with a cleaning layer and a neutral layer, a cover or film on oneside to prevent cleaning, etc.

The loading slot 12106 can have an adjunct 12130, such as any of thebuttresses, adjuncts, and/or medicants discussed above, Vicryl matrix,etc., disposed therein. The adjunct 12130 can have a variety of shapes,such as a rectangular shape. In an exemplary embodiment, the shapecorresponds to the shape of an end effector to be cleaned, such aselongate jaws of a linear surgical stapler. The adjunct 12130 can have atongue 12132 that extends from one end of the adjunct 12130 and into theopen end 12106 a of the loading slot 12106. The adjunct 12130 can extendentirely between the open end 12106 a and the closed end 12106 b of theloading slot 12106, or it can extend some distance less than entirelybetween the two ends, for example as illustrated in FIG. 88 in which theadjunct 12130 terminates before reaching the closed end 12106 b. Theadjunct 12130 can be held between the top portion 12110 and the bottomportion 12112 of the frame 12102 and can be held in place by theplurality of fingers 12116 in the groove formed by the ledges 12110 a,12112 a. The adjunct 12130 can be configured to be released by thefingers 12116 upon application of a threshold force on the adjunct 12130such that the adjunct 12130 will be free from the adjunct loader 12100.For example, the fingers 12116 can defect out of the slot as the adjunct12130 is engaged by jaws of an end effector to thereby release theadjunct 12130.

The adjunct 12130 can have a variety of configurations, as discussedabove, and can have a variety of attachment mechanisms thereon, such asan adhesive coated on a surface of the adjunct 12130. A variety ofadhesives can be used, such as 50-50 PCL-PGA, other absorbable polymerssuch as mixes of poloxamers, natural substances such as bees wax, etc.The adhesive can be spread on one or both surfaces of the adjunct 12130.For example, the adjunct 12130 can have an adhesive spread on uppersurface 12130 a of the adjunct 12130 that is configured to contact atissue-facing surface of a surgical stapler. A cover 12134 can bedisposed in the loading slot 12106 with the adjunct 12130. The cover12134 can have a variety of configurations, such as a rectangular-shapedthin sheet of material that extends between the open end 12106 a and theclosed end 12106 b of the loading slot 12106 with the adjunct 12130. Thecover 12134 can be held between the top portion 12110 and the bottomportion 12112 of the frame 12102 with the adjunct 12130 and can coverthe adhesive surface 12130 a of the adjunct 12130. The cover can be madefrom a variety of materials. For example, the cover can be a compliantbut non-porous material, various plastics, etc. The cover 12134 can beconfigured to be manually removed, although a variety of differentretraction options are possible. For example, the cover can beconfigured to automatically snap open upon use of the cleaning slot12106, be rolled up inside the adjunct loader 12100 by, for instance,having a pressure-sensitive rolling mechanism in the adjunct loader12100 that is configured to sense clamping on the cleaning pad 12120 andthen trigger rolling or retraction of the cover from the adjunct 12130,etc.

In use, the jaws of a surgical stapler can first be clamped onto thecleaning pad 12120 in the cleaning slot 12104. With the end effectorengaging the cleaning pad 12120, the jaws of the surgical stapler can bepulled out of the slot 12104. Because the surgical stapler is stillclamped on the cleaning pad 12120 as it is retracted, the cleaning pad12120 can scrub and clean the tissue facing surface of the anvil and/orthe cartridge. In some embodiments, the cleaning pad 12120 can be usedto clean just the anvil side of a surgical stapler without cleaning thecartridge side, by using the various approaches discussed above. As thesurgical stapler is retracted out of the slot 12104, the fingers 12116or other retention mechanisms can retain the cleaning pad 12120 in thecleaning slot 12104. A user can remove the cover 12134 from the loadingslot 12106 or it can be automatically removed upon cleaning, exposingthe adhesive side 12130 a of the adjunct. The user can clamp thesurgical stapler onto the adjunct 12130 in the loading slot 12106 withone of the anvil or the cartridge of the surgical stapler contacting theadhesive side 12130 a. The adjunct 12130 will attach to the tissuefacing surface adjacent the adhesive, and the jaws can be retracted fromthe slot 12106 after unclamping the jaws. Because the adjunct 12130 isattached to the surgical stapler, the adjunct will be released from theadjunct loader 12130 upon application of a threshold force, for exampleby having the fingers 12116 release the adjunct 12130 under applicationof force or by withdrawing the adjunct 12130 distally through the openend 12106 a of the loading slot 12106. The adjunct 12130 is ready fordelivery to tissue. Provided above is an embodiment of a single-step,two-stage adjunct loader. Two step loaders are also possible, in which auser clamps a surgical stapler onto a first loader that only cleans thesurgical stapler before clamping the surgical stapler onto a second,separate loader with an adjunct that loads the adjunct onto the surgicalstapler (similar to the loading process described above).

The adjunct loader 12100 illustrates an adjunct 12130 designed to beattached to only one side of a surgical stapler, but a variety of otherconfigurations are possible. For example, FIGS. 90-92 illustrate anadjunct loader 12200 that is similar to the adjunct loader 12100discussed above. The adjunct loader 12200 can have a frame 12202, acleaning slot 12204, and a loading slot 12206. The frame 12202 can havean approximate M shape with a top portion 12210 and a bottom portion12212. The top portion 12210 and the bottom portion 12212 can snap orclip together using, for example, posts 12214 that extend from one ofthe top or bottom portions 12210, 12212 and snap into the other of thetop or bottom portions 12210, 12212. The frame 12202 can have thecleaning slot 12204 and the loading slot 12206 formed therein. The slots12204, 12206 can take the form of longitudinal openings formed in theframe 12202 and can be sized and shaped to receive a linear end effectorof a surgical stapler therein, such as the staplers 10, 50. The slots12204, 12206 can extend parallel to each other and can have open ends12204 a, 12206 a on one side of the frame 12202 and closed ends 12204 b,12206 b on an opposite side of the frame 12202. The top portion 12210and the bottom portion 12212 of the frame 12202 can have ledges 12210 a,12212 a formed along the slots 12204, 12206 and configured to create agroove that extends along at least the longitudinal edges of the slots12204, 12206 when the top portion 12210 and the bottom portion 12212 aresnapped together. Each of the top portion 12210 and the bottom portion12212 of the frame 12202 can have a plurality of fingers 12216 thatextend into the slots 12204, 12206. The fingers 12216 can be configuredto retain material between the top portion 12210 and the bottom portion12212 within the slots 12204, 12206, as described above.

The cleaning slot 12204 can have a cleaning pad 12220, similar tocleaning pad 12120, that extends between the open end 12204 a and theclosed end 12204 b of the cleaning slot 12204. The cleaning pad 12220can have a rectangular shape and a tongue 12222 that extends from oneend of the cleaning pad 12220 and into the open end 12204 a of thecleaning slot 12204. The cleaning pad 12220 can be held between the topportion 12210 and the bottom portion 12212 of the frame 12202 by theplurality of fingers 12216 and/or other means described above and thegroove formed by the ledges 12210 a, 12212 a. The cleaning pad 12220 canbe made from an abrasive material with a cleaning solvent saturatedtherein and configured to remove adhesive from previous firings, tissue,oily residue, etc. The cleaning pad 12220 can be configured to have anend effector of a surgical stapler closed thereon and can be configuredto clean both sides of the surgical stapler.

The loading slot 12206 can have a first and second adjunct 12230, 12232similar to the adjunct 12130 discussed above. The first adjunct 12230can be placed on top of the second adjunct 12232 in the loading slot12206. The adjuncts 12230, 12232 can have rectangular shapes, and eachadjunct 12230, 12232 can have a tongue 12234, 12236 that extends fromone end of the adjunct 12230, 12232 adjacent the open end 12206 a of theloading slot 12206. The adjuncts 12230, 12232 can extend between theopen end 12206 a and the closed end 12206 b of the loading slot 12206.The adjuncts 12230, 12232 can be held between the top portion 12210 andthe bottom portion 12212 of the frame 12202 by the plurality of fingers12216 and the groove formed by the ledges 12210 a, 12212 a. In otherembodiments, the adjunct can be configured to be secured to the loadingslot in a variety of different ways. For example, these could includeless adhesive or less-aggressive adhesive than on the device-contactingside of the adjunct, breakaway features that pull through holes in theadjunct, etc. The adjuncts 12230, 12232 can be configured to be releasedby the fingers 12216 upon application of a threshold force such that theadjuncts 12230, 12232 will be free from the adjunct loader 12200. Theadjuncts 12230, 12232 can have a variety of configurations, as discussedabove, and can have a variety of attachment mechanisms thereon, such asan adhesive. The adhesive can be spread on an outward-facing surface12230 a, 12232 a of each of the adjuncts 12230, 12232 so that each ofthe surfaces 12230 a, 12232 a are configured to attach to atissue-facing surface of a surgical stapler. For example, the surface12230 a of the first adjunct 12230 can be configured to adhere to ananvil of a surgical stapler, while the surface 12232 a of the secondadjunct 12232 can be configured to adhere to a cartridge of the samesurgical stapler. A first cover 12240 can be disposed in the loadingslot 12206 in contact with the first adjunct 12230. The first cover12240 can be held between the top portion 12210 and the bottom portion12212 of the frame 12202 and can cover the adhesive surface 12230 a ofthe first adjunct 12230. A second cover 12242 can be disposed in theloading slot 12206 in contact with the second adjunct 12232. The secondcover 12242 can be held between the top portion 12210 and the bottomportion 12212 of the frame 12202 and can cover the adhesive surface12232 a of the second adjunct 12232. The covers 12240, 12242 can be madefrom a variety of materials, such as compliant but non-porous materials,various plastics, etc. The covers 12240, 12242 can be configured to bemanually removed, although a variety of different retraction options arepossible, as discussed above.

In use, an end effector of a surgical stapler can first be clamped ontothe cleaning pad 12220 in the cleaning slot 12204. While the jaws areclamped, the surgical stapler can be pulled away from the adjunct loader12200. The cleaning pad 12220 can scrub and clean the tissue-facingsurface of each jaw as it is removed. As the surgical stapler is pulledaway from the adjunct loader 12200, the fingers 12216 will retain thecleaning pad 12220 in the cleaning slot 12204. A user can remove thefirst and second covers 12240, 12242 from the loading slot 12206, orthey can retract automatically, exposing the adhesive sides 12230 a,12232 a of the first and second adjuncts 12230, 12232. The user canclamp the surgical stapler onto the adjuncts 12230, 12232 such that theanvil of the surgical stapler closes on the adhesive side 12230 a of thefirst adjunct 12230, and the cartridge of the surgical stapler closes onthe adhesive side 12232 a of the second adjunct 12230. Clamping cancause the fingers 12216 to deflect, such as retracting into the frame12202. The first and second adjuncts 12230, 12232 will attach to thejaws, and the surgical stapler can be unclamped and pulled away from theadjunct loader 12200. This motion will cause the adjuncts 12230, 12232to be pulled away as well, and the adjuncts 12230, 12232 can then bedeployed in an operation.

While the covers can be manually removed, covers in other embodimentscan be automatically retracted upon clamping of a surgical stapler onthe cleaning pad. For example, FIGS. 93-94 illustrate an adjunct loader12300 similar to the adjunct loader 12200. The adjunct loader 12300 canhave a frame 12302, a cleaning slot 12304, and a loading slot 12306. Theframe 12302 can have an approximate M shape and can have internalsupport structures. For example, posts 12316 can extend inward from theframe 12302 to provide support to an upper internal framework 12318 anda lower internal framework 12320. The upper and lower internal framework12318, 12320 can extend throughout an interior of the frame 12302 and beconfigured to provide support to material disposed within the slots12304, 12306 and to facilitate receipt of the end effector. For example,the upper and lower internal framework 12318, 12320 can have angled ends12318 a, 12320 a that extend at an angle into the slots 12304, 12306 toguide the jaws into the slots 12304, 12306. The slots 12304, 12306 cantake the form of longitudinal openings formed in the frame 12302 and canbe sized and shaped to receive a linear end effector of a surgicalstapler therein, such as the staplers 10, 50. The slots 12304, 12306 canextend parallel to each other and can have open ends on one side of theframe 12302 and closed ends on an opposite side of the frame 12302.

The cleaning slot 12304 can have a cleaning pad 12322, similar tocleaning pad 12220, that extends between the open end 12304 a and theclosed end 12304 b of the cleaning slot 12304. A cleaning supportstructure 12324 can be disposed in one of the outer legs of the M shapedframe 12302, extending between an external wall 12326 of the frame 12302and the cleaning pad 12322, and it can be configured to hold alongitudinal edge of the cleaning pad 12322 in the cleaning slot 12304.On an opposite side of the cleaning pad 12322 and disposed within theinner leg of the M shaped frame 12302 is a movable lever 12328 that hasan approximately L shaped cross-sectional shape. A first end 12328 aholds a longitudinal edge of the cleaning pad 12322 opposite to thecleaning support structure 12324. The movable lever 12328 extendsthrough an interior of the frame 12302 toward the loading slot 12306. Asecond end 12328 b of the movable lever 12328 can be disposed in contactwith an adjunct cover 12330. The cleaning support structure 12324 andthe movable lever 12328 are configured to move up and down togetherwithin the frame 12302 and to be initially in contact with the angledends 12318 a that extend at an angle into the cleaning slot 12304.

The loading slot 12306 can have an adjunct 12350 similar to the adjunct12230 that extends between the open end 12306 a and the closed end 12306b of the loading slot 12306. A rectangular-shaped adjunct support 12346can be disposed in one of the outer legs of the M shaped frame 12302 onthe opposite side to the cleaning support structure 12324, extendingfrom an external wall 12342 of the frame 12302 and into the loading slot12306, and it can be configured to hold the adjunct 12350 in the loadingslot 12306. A spring 12344 can be disposed between the external wall12342 and the adjunct cover 12330 and inside the outer leg of the Mshaped frame 12302 with the adjunct support 12346.

The cleaning pad 12322 can have a rectangular shape and a tongue thatextends from one end of the cleaning pad 12322 adjacent the open end12304 a of the cleaning slot 12304. The cleaning pad 12322 can be heldbetween the upper and lower internal framework 12318, 12320 and can beheld in the cleaning slot 12304 initially against the angled ends 12318a. In one embodiment, the cleaning pad 12322 can be made from anabrasive material with a cleaning solvent saturated therein andconfigured to remove tissue and oily residue. The cleaning pad 12322 canbe configured to have an end effector of a surgical stapler clampedthereon and it can be configured to clean one or both sides of thesurgical stapler.

The adjunct 12350 can have first and second portions 12350 a, 12350 bsimilar to the adjuncts 12230, 12232. The first portion 12350 a can beplaced on top of the adjunct support 12346, and the second portion 12350b can be placed on bottom of the adjunct support 12346. The first andsecond portions 12350 a, 12350 b can have rectangular shapes, and eachportion 12350 a, 12350 b can have a tongue that extends adjacent theopen end 12306 a of the loading slot 12306. The first and secondportions 12350 a, 12350 b of the adjunct 12350 can extend between theopen end 12306 a and the closed end 12306 b of the loading slot 12306.The adjunct 12350 can be held between the upper and lower internalframework 12318, 12320. The adjunct 12350 can have a variety ofconfigurations, as discussed above, and can have a variety of attachmentmechanisms thereon, such as an adhesive. The adhesive can be spread onan outward-facing surface of each of the first and second portions 12350a, 12350 b so that each of the surfaces is configured to attach to atissue-facing surface of a surgical stapler.

In this embodiment, the cross-sectional shape of the cover 12340 is Ushaped with upper and lower horizontal sidewalls and a shorter verticalsidewall extending therebetween. The cover 12340 can be disposed in theloading slot 12306 such that it surrounds the adjunct 12350. Each of theupper and lower sidewalls of the U shaped cover 12340 can initiallyextend over the first and second portions 12350 a, 12350 b of theadjunct 12350 and can be configured to cover and protect the adjunct12350 until use. The vertical sidewall of the U shaped cover 12340 canbe disposed within the interior of the inner leg of the M shaped frame12302 and can contact the second end 12328 b of the lever arm 12328.Ends of the upper and lower sidewalls of the cover 12340 opposite thevertical sidewall can extend into the outer leg of the M shaped frame12302 with the adjunct support 12346 and the spring 12344, and one ofthe ends of the upper and lower sidewalls of the cover 12340 can bedisposed in contact with the spring 12344.

Initially, the cleaning pad 12322 can be held in an upper startingposition in which the lever arm 12328 and the cleaning support structure12324 support the cleaning pad 12322 and both contact the angled ends12318 a of the upper interior framework 12318. The second end 12328 b ofthe lever arm 12328 can extend through the interior of the frame 12302to the loading slot 12306 and can contact the cover 12340. The arm 12328can act on the cover 12340 to force the cover toward the spring 12344,keeping the spring 12344 compressed between the cover 12340 and theouter wall 12342 and keeping the cover 12340 over the adjunct 12350.When a surgical stapler, such as the stapler 12360, clamps onto thecleaning pad 12322, the movement causes the cleaning pad 12322 to movedownward. With movement of the cleaning pad 12322, the cleaning supportstructure 12324 and the lever arm 12328 both move downward as well. Asthey move downward, the second end 12328 b of the lever arm 12328 movesout of contact with the cover 12340. As soon as the lever arm 12328 isno longer in contact with the cover 12340, the spring 12344 decompressesand forces the cover 12340 to move toward the cleaning slot 12304 andout of the loading slot 12306. The cover 12340 will come to rest in theinner leg of the M shaped frame 12302 with the lever arm 12328, leavingthe adjunct 12350 uncovered, as shown in FIG. 94. The spring 12344 canbe located at only a single point along the frame 12302, so the spring12344 will not block access of a surgical stapler to either side of theadjunct 12350. In some embodiments, the spring can be anchor in a centerposition and can be held in a stretched state by the lever. Whenreleased, the spring can be configured to retract and pull the covers tothe center position. In such embodiments, there is thus no concern withthe spring being too off-center to pull the covers or be in the way ofthe adjuncts. After a user finishes cleaning the end effector of thesurgical stapler 12360, the surgical stapler 12360 can be clamped ontothe adjunct 12350 so that the first and second portions 12350 a, 12350 bwill each attach to opposite sides of the surgical stapler 12360, asdescribed above.

Some embodiments can lack covers while still protecting the adjunct frombeing disturbed before a user is ready to attach the adjunct to astapler. For example, FIGS. 95-96 illustrate an adjunct loader 12400similar to the adjunct loader 12300 but lacking a formal cover. Theadjunct loader 12400 can have a frame 12402, a cleaning slot 12404, anda loading slot 12406. The frame 12402 can have an approximate M shapeand can have internal support structures. For example, posts 12416 canextend inward from the frame 12402 to provide support to an upperinternal framework 12418 and a lower internal framework 12420. The upperand lower internal framework 12418, 12420 can extend throughout aninterior of the frame 12402 and can be configured to provide support tomaterial disposed within the slots 12404, 12406. For example, the upperand lower internal framework 12418, 12420 can have angled ends 12418 a,12420 a that extend at an angle into the slots 12404, 12406 for engagingadjunct or cleaning material, and for guiding jaws into the slots 12404,12406. The cleaning slot 12404 and the loading slot 12406 can be formedin the frame 12402. The slots 12404, 12406 can take the form oflongitudinal openings through the frame 12402 and can be sized andshaped to receive a linear end effector of the surgical stapler therein,such as the staplers 10, 50. The slots 12404, 12406 can extend parallelto each other and can have open ends on one side of the frame 12402 andclosed ends on an opposite side of the frame 12402.

The cleaning slot 12404 can have a cleaning pad 12422, similar tocleaning pad 12322, that extends between the open end 12404 a and theclosed end 12404 b of the cleaning slot 12404. A cleaning supportstructure 12424 is disposed in one of the outer legs of the M shapedframe 12402, extending between an external wall 12426 of the frame 12402and the cleaning pad 12422, and it can be configured to hold alongitudinal edge of the cleaning pad 12422 in the cleaning slot 12404.Unlike cleaning support structure 12324, structure 12424 is immovableand is fixed in place. On an opposite side of the cleaning pad 12422 anddisposed within the inner leg of the M shaped frame 12402 are upper andlower levers 12428, 12429. The levers 12428, 12429 each have a long,rectangular shape and an arm 12428 a, 12428 b that extends into thecleaning slot 12404. A spring 12430 is disposed between the levers12428, 12429 and biases the levers 12428, 12429 away from each othersuch that the upper lever 12428 is configured to extend along the upperinternal framework 12418 and the lower lever 12429 is configured toextend along the lower internal framework 12420 in an initial position.The levers 12428, 12429 extend through an interior of the frame 12402toward the loading slot 12406. Second ends 12428 b, 12429 b of the upperand lower levers 12428, 12429 are disposed above and below,respectively, upper and lower applicators 12442, 12443 with nozzles12442 a, 12443 a that face into the loading slot 12406. The upper andlower levers 12429, 12429 are configured to move up and down withapplication of force to the arms 12428 a, 12429 a that overcomes thespring force of spring 12430.

The loading slot 12406 can have upper and lower adjuncts 12450, 12451,similar to adjunct 12350, that extends between the open end 12406 a andthe closed end 12406 b of the loading slot 12406. A rectangular-shapedadjunct support 12446 is disposed in one of the outer legs of the Mshaped frame 12402 on the opposite side to the cleaning supportstructure 12424, extending from an external wall 12442 of the frame12402 across the loading slot 12406 and terminating in the inner leg ofthe M shaped frame 12402, and it is configured to hold the adjuncts12450, 12451 in the loading slot 12406.

The cleaning pad 12422 can have a rectangular shape and a tongue thatextends from one end of the cleaning pad 12422 and adjacent the open end12404 a of the cleaning slot 12404. The cleaning pad 12422 can be heldbetween the upper and lower internal framework 12418, 12420 and betweenthe arms 12428 a, 12429 a of the upper and lower levers 12428, 12429. Inone embodiment, the cleaning pad 12322 can be made from an abrasivematerial with a cleaning solvent saturated therein and configured toremove tissue and oily residue. The cleaning pad 12422 can be configuredto have an end effector of a surgical stapler closed thereon and can beconfigured to clean one or both sides of the surgical stapler, such asthe anvil side.

The upper adjunct 12450 can be placed on top of the adjunct support12446, and the lower adjunct 12451 can be placed on bottom of theadjunct support 12446. The adjuncts 12450, 12451 can have rectangularshapes, and each one can have a tongue that extends adjacent the openend 12406 a of the loading slot 12406. The adjuncts 12450, 12451 canextend between the open end 12406 a and the closed end 12406 b of theloading slot 12406. The adjuncts 12450, 12451 can be held between theupper and lower internal framework 12418, 12420. The adjuncts 12450,12451 can have a variety of configurations, as discussed above, and canhave a variety of attachment mechanisms. For example, the adjuncts12450, 12451 can have no attachment mechanism thereon, and instead canbe positioned adjacent to the upper and lower applicators 12442, 12443.

Initially, as shown in FIG. 95, the upper and lower arms 12428 a, 12429a are expanded above and below the cleaning pad 12422. The second ends12428 b, 12429 b can extend through the interior of the frame 12402 tothe loading slot 12406 and are positioned above and below the upper andlower applicators 12442, 12443. The spring 12430 keeps the upper andlower levers 12429, 12429 in this expanded configuration. When asurgical stapler, such as the stapler 12460, clamps onto the cleaningpad 12422, the stapler 12460 clamps onto the arms 12428 a, 12429 a ofthe upper and lower levers 12428, 12429 and forces the arms 12428 a,12429 a to move toward one another against resistance of the spring12430. The compressing movement of the arms 12428 a, 12429 a cause theupper and lower levers 12428, 12429 to move toward one another, causingthe ends 12428 b, 12429 b to also move toward one another. The ends12428 b, 12429 b compress against the upper and lower applicators 12442,12443, causing adhesive to squirt from the nozzles 12442 a, 12443 a thatface into the loading slot 12406. An adhesive is thus applied to theoutward facing surfaces of the adjuncts 12450, 12451. A person skilledin the art will appreciate that multiple applicators can be disposedalong the entire length of each adjunct, as needed. After a userfinishes cleaning the surgical stapler 12460, the surgical stapler 12460can be clamped onto the upper and lower adjuncts 12450, 12451 with thenewly applied adhesive so that the upper and lower adjuncts 12450, 12451will each attach to opposite sides of the jaws of the surgical stapler12460.

While the adhesive is applied in this embodiment, other applicationmethods are possible. For example, in some embodiments a heat activatedor softened adhesive can be applied to the adjunct. Clamping a surgicalstapler onto a cleaning side of an adjunct loader can activate a heaterwithin the loader that can heat and/or apply a heat activated orsoftened adhesive to the adjunct(s). For instance, the stapler can clamponto the adjunct, causing the loading slot to sense the presence of thestapler and hold the end effector while heating PDS attachment pointsthat affix adjuncts to one or both sides of the end effector. In such anembodiment, lights on the adjunct loader (such as green and red LEDs)can indicate when the adjunct(s) are attached and when the adjunctloader releases the end effector.

The adjunct loaders are not limited to horizontal configurations ormanual cleaning and loading. For example, in some embodiments a box canbe used with vertical slots. The first slot can have a cleaning systemto clean the end effector, similar to the methods described above orincorporating a motor, solvents, scrub brushes, etc. Another slot couldapply the adjunct, similar to the methods described above or by amotorized process. In other embodiments activation of the cleaning stepcould automatically trigger the loading step. In various embodiments,cleaning and loading can be disposed in separate housings.

End Effector with Adjunct Materials

An adjunct can be releasably retained on a jaw of an end effector for asurgical tool using various retaining or attachment features. In someimplementations, the attachment feature can be disposed over the adjunctmaterial and it can be releasably coupled to the jaw on which theadjunct is disposed. The adjunct material can be separated from the jawin a suitable way. For example, the attachment feature retaining theadjunct on the jaw can be cut by a suitable cutting element (e.g., aknife) as the cutting element translates distally to cut tissue retainedbetween the jaws. In some embodiments, when staples are ejected fromstaple-holding cavities of a cartridge, the staples cause the adjunctmaterial to be separated from the jaw. For example, the force with whichthe staples are ejected can cause the adjunct material to be disengagedfrom the jaw. Additionally or alternatively, one or more portions of theattachment feature, or the entire attachment feature can bebiodegradable and/or bioabsorbable, and the attachment feature or aportion thereof can therefore remain with the adjunct material when itis transferred to a treatment site in a patient.

In some implementations, an adjunct material is releasably retained on ajaw of an end effector using an attachment feature having a retainingfilament. The retaining filament can have an intermediate portion andfirst and second ends disposed on opposed sides of the intermediateportion. Each of the first and second ends can have a respective endfeature configured to mate with the jaw. To retain the adjunct materialon the jaw, the attachment feature can be arranged such that at least apart of its intermediate portion is disposed over the adjunct materialand such that the first and second ends are spaced apart. The first andsecond ends can be disposed on a side of the jaw opposed to thetissue-facing surface, and they can be spaced apart across a cuttingelement channel of the jaw. It should be appreciated that, the “first”and “second,” as used herein in connection with the ends of theretaining filament or in connection with any other elements, features,or portions described herein, are used for the description purposedonly, and not to indicate any particular order.

FIGS. 97-99 illustrate an implementation of an adjunct material 13100releasably retained on a jaw of an end effector 13102 in accordance withthe described techniques. The end effector 13102, shown only partiallyin FIG. 97, can be used with any suitable surgical instrument, forexample, a linear surgical stapler (e.g., stapler 10 in FIG. 1, stapler50 in FIG. 4, or any other surgical stapler) that is suitable for usewith at least one adjunct. The end effector 13102 can be coupled to adistal end of a shaft of the surgical stapler (not shown). The jaw ofthe end effector 13102 is in the form of a cartridge body 13104 with aplurality of staple cavities configured to seat staples therein. Thestaple cavities, which are obscured by the adjunct material 13100 inFIG. 97, open on a tissue-facing surface 13106 of the cartridge body13104. The cartridge body 13104 can be or can have a removable andreplaceable cartridge retained therein, or, in some embodiments, thecartridge body 13104 can be part of a disposable loading unit removablycoupled to an elongate shaft of a surgical instrument.

Although not shown in FIG. 97, the end effector 13102 also has an anvilopposing the cartridge body 13104, with a plurality of staple formingcavities formed on a tissue-facing surface thereof. It should beappreciated that the adjunct material 13100 is shown in FIG. 97 to bereleasably retained on the jaw in the form of the cartridge body 13104by way of example only, as an adjunct material can be retained in asimilar manner on an anvil of an end effector as well.

As shown in FIG. 97, the adjunct material 13100 is retained on thecartridge body 13104 using an attachment feature in the form of anelongate retaining filament 13108. In this implementation, the retainingfilament 13108 has an intermediate portion 13110 and first and secondends 13112 a, 13112 b disposed on opposed sides of the intermediateportion 13110, which are shown in FIG. 99. As shown in FIG. 97, theretaining filament 13108 is arranged on the cartridge body 13104 suchthat at least a part of the intermediate portion 13110 is disposed overthe adjunct material 13100. The intermediate portion 13110 of theretaining filament 13108 also encompasses opposed sides walls of thecartridge body 13104, one of which, side wall 13105, is shown in FIG.97.

In this implementation, the intermediate portion 13110 of the retainingfilament 13108 extends over the side walls of the cartridge body 13104such that the first and second ends 13112 a, 13112 b are spaced apart.In particular, the first and second ends 13112 a, 13112 b are disposedon a side 13116 (back side when the end effector's jaws are closed) ofthe cartridge body 13104 that is opposed to the tissue-facing surface13106 thereof, as shown in FIG. 99. The first and second ends 13112 a,13112 b can be spaced apart across a cutting element channel 13113 ofthe cartridge body 13104 extending longitudinally across a mid-portionof the cartridge body 13104.

At least a portion or the entirety of the retaining filament 13108 canbe removably attached to the cartridge body 13104 in a variety ofdifferent ways. For example, in the illustrated embodiments, theretaining filament 13108 can be attached to the cartridge body 13104using a hot-melt adhesive or any other suitable type of adhesive or gluematerial. The adhesive can be, for example, polydioxanone (PDO) that canfunction as an adhesive when heated. Additionally or alternatively,cyanoacrylates or UV curing adhesives can be used.

The retaining filament 13108 can be used to retain the adjunct material13100 on the jaw 13104 using one or more suitable features that can beformed on the jaw and/or on the adjunct material. In the illustratedexample, as shown in FIGS. 97 and 98, the cartridge body 13104 hasretaining members 13118 a, 13118 b disposed at opposed sides 13120 a,13120 b of the tissue-facing surface 13106 in proximity to therespective edges of the tissue-facing surface 13106. Each of theretaining members 13118 a, 13118 b can be in the form of a pair ofadjacent posts, each of which is configured to engage at least a part ofthe intermediate portion 13110 of the retaining filament 13108. FIG. 98,showing the retaining member 13118 a, illustrates a pair of adjacentposts 13122 d, 13122 p disposed on the side 13120 a of the tissue-facingsurface 13106 of the cartridge body 13104, in proximity to the edge13121 a of the tissue-facing surface 13106. The distance between theadjacent posts 13122 d, 13122 p is such that the posts 13122 d, 13122 pengage the part of the intermediate portion 13110, indicated in FIG. 98as the part 13124 that extends between the posts 13122 d, 13122 p. Thepart 13124 of the retaining filament 13108 passing between the posts13122 d, 13122 p can be engaged with the posts 13122 d, 13122 p viainterference fit. As shown in FIG. 97, similar to the retaining member13118 a (FIG. 98), the retaining member 13118 b formed on the oppositeside 13120 b of the tissue-facing surface 13106 can be in the form of apair of adjacent posts.

In some embodiments, the posts in a pair of posts formed on thetissue-facing surface of the jaw can be spaced from one another suchthat they have a portion of the retaining filament (e.g., anintermediate portion) passing therethrough without being engaged betweenthe posts. In this way, the posts ensure that the retaining filament ispositioned as desired and prevent the retaining filament from slidingproximally or distally. Additionally or alternatively, the retainingfilament can be retained over the jaw's surface using adhesive which canbe used to couple one or more portions of the retaining filament to thejaw.

As shown in FIGS. 97 and 98, the posts 13122 d, 13122 p are disposedalong the edge 13121 a such that the post 13122 d is more distal (e.g.,closer to the distal end 13104 d of the cartridge body 13104) than theadjacent post 13122 p. Also, in the illustrated exemplaryimplementation, the posts 13122 d, 13122 p are offset by the same orsubstantially the same distance from the edge of the cartridge body13104 such that the posts 13112 d, 13112 p are disposed along the sameline parallel to a longitudinal axis 13A1 of the cartridge body 13104.It should be appreciated, however, that the posts 13122 d, 13122 p canbe disposed on the tissue-facing surface 13106 in other ways. Moreover,more than two posts or other retaining elements can be formed on thetissue-facing surface 13106 for engaging the part of the intermediateportion 13110. Furthermore, in some embodiments, the retaining membercan be in the form of a single element formed on the tissue-facingsurface 13106, the single element having one or more prongs, arms, orother retaining elements configured to frictionally engage an attachmentfeatures therebetween. As another options, different types of retainingmembers can be formed on opposed sides of the tissue-facing surface ofthe jaw of an end effector.

The adjunct material 13100 releasably retained on the tissue-facingsurface 13106 of the jaw 13104 can have a variety of differentconfigurations. As shown in FIG. 97, the adjunct material 13100 isgenerally rectangular and it is sized such that its width issubstantially the same as the width of the tissue-facing surface 13106.The length of the adjunct material 13100 can be greater than that of thetissue-facing surface 13106—as shown in FIG. 97, the adjunct 13100extends distally beyond the tissue-facing surface 13106. This makes itpossible to retain the adjunct 13100 using the retaining members 13118a, 13118 b formed at close proximity to the distal end of thetissue-facing surface 13106.

The adjunct material 13100 can have features that facilitate itstemporary engagement with the cartridge body 13104. Thus, as shown inFIGS. 97 and 98, the adjunct material 13100 has cut-outs 13126 a, 13126b formed on opposite sides thereof such that the retaining members 13118a, 13118 b are disposed within the cut-outs 13126 a, 13126 b,respectively.

In the illustrated implementation, the cartridge body 13104 can have, inaddition to the retaining members 13118 a, 13118 b, other features thatfacilitate releasable attachment of the adjunct material 13100 to thecartridge body 13104. Thus, as shown in FIG. 99, the side 13116 of thecartridge body 13104 opposed to the tissue-facing surface 13106 hasroughened portions 13130 a, 13130 b which the first and second ends13112 a, 13112 b of the retaining filament 13108 engage frictionally.The first and second ends 13112 a, 13112 b can have end features in theform of flattened leaf portions or members 13114 a, 13114 b (or othertypes of end features) formed thereon that are configured tofrictionally engage with the roughened portions 13130 a, 13130 b,respectively. FIG. 99 illustrates that the first and second ends 13112a, 13112 b with the leaf members 13114 a, 13114 b are spaced apartacross the cutting element channel 13113 of the cartridge body 13104.

The leaf portions can be formed in a variety of ways. For example, theycan be pre-formed elements with a texture and/or surface features thatallow them to engage the roughened portions. In some embodiments,however, the leaf portions can be formed by heat-pressing or otherwiseprocessing end portions of the retaining filament to flatten them andthus form leaf-like ends. In such embodiments, the end portions of theretaining filament can be caused to deform and to be “pressed” onto theroughened portions. The heat pressing can be performed in a variety ofways, for example, by pressing the end portion of the retaining filament(which can be made from a thermoplastic material) into the roughenedportions with a heated iron device so that the thermoplastic material isheated and cooled after mechanically “locking” into the roughenedportions of the jaw.

The roughened portions 13130 a, 13130 b can be created in many differentways. In the illustrated implementation, they are formed by modifying asurface texture of a portion of the cartridge's side 13116. For example,the portions of the cartridge's side 13116 can be knurled or otherwiseroughened to create the roughened portions 13130 a, 13130 b of a desiredsize at appropriate locations. FIG. 101 illustrates an example of aknurled or roughened portion 13140, which can be any of the roughenedportions 13130 a, 13130 b. As shown in FIG. 101, the roughened portion13140 has a regular pattern of small four-sided pyramids, though theregular pattern can be formed from elements of any other type(s). Also,the roughened portion 13140 can be an irregular rough portion configuredto engage with a portion of an attachment feature, e.g., the first andsecond ends 13112 a, 13112 b with the leaf portions 13114 a, 13114 b orwith otherwise shaped elements.

The roughened portions 13130 a, 13130 b can be created in any suitablemanner. For example, they can be created by laser etching, chemicallyetching, heat altering (flame treated, heat pressed/stamped, etc.) ormechanically etching (grinding, sand blasting, CO₂ blasting, etc.) thesurface of the jaw. In some implementations, the roughened portions13130 a, 13130 b can be created by depositing certain materials (e.g.,pressure-sensitive adhesives) over the surface of the cartridge body13104, or by otherwise modifying the texture of a portion of the side13116 of the cartridge body 13104.

Accordingly, in the example of FIGS. 97-99, a mid-portion of theintermediate portion 13110 of the retaining filament 13108 extends overthe adjunct material 13100 and portions extending from both sides of themid-portion encompass the opposed side walls of the cartridge body 13104such that the spaced apart first and second ends 13112 a, 13112 b aredisposed over the side 13116 opposed to the tissue-facing surface 13106.The adjunct material 13100 is releasably retained on the cartridge body13104 using the pairs of the adjacent posts 13118 a, 13118 b and theroughened portions 13130 a, 13130 b.

The retaining filament 13108 can have any form and it can be made fromany suitable materials. For example, it can be in the form of a suture,wire, cable, strap, or in any other form. It can be made from anysuitable absorbable or non-absorbable polymers, examples of whichinclude polyglactin, polyglycolic acid, catgut, polyglecaprone,polydioxanone, etc. Non-limiting examples of non-dissolvable suturematerials include polypropylene, polyamide, polyester, silk, etc. Insome embodiments, the retaining filament 13108 can be formed from atleast partially resilient and/or pliable material such that it can bemanipulated to conform to a shape of a body of a jaw which it partiallyencompasses.

The end features in the form of leaf members 13114 a, 13114 b formed onthe first and second ends 13112 a, 13112 b of the retaining filament13108, which can be formed integrally with the retaining filament 13108or can be coupled to the retaining filament 13108 in a suitable manner,can also be formed from any suitable material(s), including theabsorbable or non-absorbable polymers mentioned above. As mentionedabove, each leaf member can be formed by pressing (e.g., heat-pressing)a portion of the retaining filament onto the jaw's surface. In someimplementations, the leaf members 13114 a, 13114 b, or other membersconfigured to engage the roughened portions 13130 a, 13130 b, can bemade from a relatively rigid material. The leaf members 13114 a, 13114 bcan have surface features (e.g., ridges, hooks, barbs, or any otherprotruding features) formed thereon that allow the leaf members 13114 a,13114 b to frictionally and removably engage with the roughened portions13130 a, 13130 b. Furthermore, in some embodiments, the leaf members13114 a, 13114 b can be formed from at least partially magnetic materialsuch that they can be magnetically retained on the roughened portions13130 a, 13130 b. Also, in other embodiments, the leaf members 13114 a,13114 b can be coupled to the roughened portions 13130 a, 13130 b usinga polymer-based magnetic gels, or in other manner.

The roughened portions can be formed at any one or more portions of thejaw that can be engaged with a retaining filament. In theimplementations described above, the roughened portions can be formed ona side that is opposite to a tissue-facing surface, such as an upperside of an anvil or a backside of a cartridge. In some implementations,additionally or alternatively, regardless of their configuration(s) andthe way in which they are formed, one or more roughened portions can beformed on various others portions of a jaw of an end effector. Forexample, FIG. 100 shows an example of a jaw 13202 of an end effectorhaving an adjunct material 13200 releasably retained thereon using anattachment feature. The attachment feature is in the form of a retainingfilament 13201 engaged with roughened portions formed on opposed sidewalls of the jaw 13202. The engagement can be chemical (e.g., using anadhesive), frictional or other mechanical engagement, or any other typeof engagement, including a combination of different ways. In someembodiments, a heat pressing approach can be used to allow mechanicalinterlocks of complementary matches of the surface geometry.

In this example, the jaw 13202 is in the form of a cartridge body whichcan be similar to the cartridge body 13104 in FIGS. 97-99. The adjunctmaterial 13200, which can be similar to the adjunct material 13100(FIGS. 97-99) is disposed on a tissue-facing surface 13206 of the jaw13202. Similar to the adjunct material 13100, the adjunct material 13200has cut-outs 13203 a, 13203 b formed in proximity to a distal end 13200d thereof on both long sides of the adjunct 13200.

As shown in FIG. 100, side walls of the cartridge body 13104 can beroughened, which can be done in a manner similar to a manner in whichthe roughened portions 13130 a, 13130 b are created on the cartridgebody 13104. FIG. 100 illustrates that a portion of one of the side walls(13208) of the jaw 13202 is roughened to thus form a roughened portion13210. A portion 13205 of the retaining filament 13201, encompassing theside wall of the jaw 13202, frictionally engages the roughened portion13210 and thereby releasably retains the adjunct material 13200 on thejaw 13202. The opposite side of the jaw 13202, which is not shown inFIG. 100, can have similar roughened portion which the retainingfilament 13201 encompassing that side wall frictionally engages. The jaw13202 can also have one or more roughened portions on a side thereofthat is opposed to its tissue-facing surface 13206, and such roughenedportions can be similar to the roughened portions 13130 a, 13130 b ofthe jaw 13204 shown in FIG. 99. Also, although the jaw 13202 is shownwithout any other retaining features that can be used to temporarilyengage the retaining filament 13201 with the jaw 13202, it should beappreciated that the jaw 13202 can have other retaining features. Forexample, the jaw 13202 can include retaining members similar to theretaining members 13118 a, 13118 b in the form of pairs of adjacentposts (FIGS. 97 and 98), roughened portions on the backside side of thejaw and/or any other retaining features.

FIG. 102 illustrates another implementation of retaining members formedon a jaw 13302 of an end effector having an adjunct material 13300releasably retained thereon. In this example, a side 13304 (upper side)of the jaw 13302 that is opposite to a tissue-facing surface of the jaw13302 is shown (e.g., the side 13116 of the jaw 13102 in FIG. 99). InFIG. 102, the jaw 13302 is in the form of an anvil. However, as a personskilled in the art will appreciate, an end effector's jaw havingretaining members as described in connection with FIG. 102 can be acartridge body.

The adjunct material 13300 is releasably retained on the jaw 13302 usingan attachment feature in the form of a retaining filament 13301,portions of which are shown in FIG. 102. The retaining filament 13301has an intermediate portion a part of which is disposed over the adjunct13300 (not shown in FIG. 102) and other parts of which (e.g., 13303)encompass the jaw's side wall.

The retaining filament 13301 also has first and second ends 13305 a,13305 b disposed on both sides of the intermediate portion adjacent tothe parts of the retaining filament 13301 encompassing the side wall ofthe jaw 13302. In the example shown in FIG. 102, the first and secondends 13305 a, 13305 b are disposed on the upper side 13304 of the jaw13302 and retained on that side via the respective retaining members.The retaining members are spindle-type retaining members 13306 a, 13306b disposed on opposed sides of the surface of the jaw's side 13304 inproximity to the edges of the jaw 13302. Each of the spindle-typeretaining members 13306 a, 13306 b is a generally cylindrical memberhaving a relatively small diameter and height. For example, in at leastone embodiment, the diameter of the retaining members 13306 a, 13306 bcan be about 0.060 inches, and its height can be about 0.025 inches.Regardless of its size, each of the of the spindle-type retainingmembers 13306 a, 13306 b has a radial recess formed in the member's sidewall around the entire circumference of the wall. Thus, FIG. 102 showsthat the retaining members 13306 a, 13306 b have radial recesses 13308a, 13308 b, respectively. The retaining members 13306 a, 13306 b alsohave respective holding notches or recesses 13310 a, 13310 b that areformed along each of the member's diameter on the top side of thatmember.

It should be appreciated that the spindle-type retaining members 13306a, 13306 b are shown in FIG. 102 by way of example only, and that anyother features can be used to couple the retaining filament to the jaw.For example, in some embodiments, the jaw (a cartridge or an anvil) canbe configured to decrease in width so as to “grab” the filament. Asanother example, the jaw can have a groove with a cam feature, a postwith an adjacent cam feature, or any other feature(s) configured toretain the retaining filament which can be a rope, wire, suture, thread,or any other element.

The radial recesses 13308 a, 13308 b and the holding recesses 13310 a,13310 b are used to retain therein a portion of the at least one of thefirst and second ends 13305 a, 13305 b. In particular, as shown in FIG.102, the retaining member 13306 a has the first end 13305 a of theretaining filament 13301 receiving within the radial recess 13308 a suchthat the first end 13305 a is wrapped around the retaining member 13306a. After the first end 13305 a encircles the retaining member 13306 a atleast once, a portion of the first end 13305 a is fittingly receivedthrough the top recess 13310 a of the retaining member 13306 a. In thisway, the first end 13305 a of the retaining filament 13301 engages withthe retaining member 13306 a.

The holding recesses 13310 a, 13310 b can have a configuration thatfacilitates retention of a portion of the retaining filament 13301. Forexample, the holding recess 13310 b of the retaining member 13306 b(shown in FIG. 102 free of the retaining filament for the illustrationpurposes only) has a first wider portion 13307 and a second, narrowerportion 13309 extending from the first portion 13307. The holding recess13310 a of the retaining member 13306 a is configured in a similarmanner. In use, after a portion of the second end 13305 b of theretaining filament 13301 is wrapped around the radial recess 13308 b,the first portion 13307 receives therein another portion of the secondend 13305 b and this filament's portion is then received through thenarrower portion 13309 of the holding recess 13310 b so as to befittingly retained therein. Thus, in use, the second end 13305 b can beslightly stretched and passed through the holding recess 13310 b so asto be retained within the recess. The first end 13305 a is engaged withthe holding recess 13310 a in a similar manner and is shown in FIG. 102as being wrapped around the radial recess 13308 a and retained withinthe holding recess 13310 a. In this way, both ends of the retainingfilament 13301 are temporarily engaged with the jaw 13302.

As in the examples above, the retaining filament 13301 can be disengagedfrom the jaw 13302 when a knife or other cutting element traverses acutting element channel 13313 and thereby cuts a portion of theretaining filament 13301 disposed over the adjunct material 13300. Therest of the retaining filament 13301 remains with the jaw 13302.

It should be appreciated that, regardless of the specific configurationsof attachment features (e.g., retaining filaments or other features)described herein, jaw(s) of an end effector, the attachment features,and one or more adjunct materials are configured such that the jawhaving one or more adjunct materials releasably retained thereon usingone or more attachment features fits within a trocar. In someembodiments, one or more attachment features (e.g., posts or otherfeatures) can be formed at a bottom of one or more recesses formed in ajaw, such that the attachment features do not affect the overall size ofthe jaw. The adjunct material(s) are configured to be retained on thejaw in a manner that does not interfere with normal manipulations andoperation of the jaw.

An adjunct material can be releasably retained on an end effector's jawusing various other types of attachment features in the form of aretaining filament. For example, in some implementations, an attachmentfeature has an intermediate portion and first and second ends withdeformable elements. The deformable elements can be configured suchthat, when the attachment feature is disposed over an adjunct materialplaced on the jaw of an end effector, the deformable elements reversiblydeform and change their configuration as they are received withinopenings or recesses in the jaw. When the deformable elements areengaged with the recesses in the jaw, they at least partially adopttheir non-deformed configuration to thus retain the attachment featurein place.

FIGS. 103 and 104 illustrate an example of an adjunct material 13400configured to be releasably retained on a jaw 13402 of an end effectorusing an attachment feature 13401. The attachment feature 13401 has anintermediate portion 13404 and first and second ends 13406 a, 13406 b.The intermediate portion 13404, in turn, includes a mid-portion 13408and first and second arm portions 13410 a, 13410 b extending fromopposite sides of the mid-portion 13408 and terminating at the first andsecond ends 13406 a, 13406 b. As shown in FIGS. 103 and 104, the firstand second ends 13406 a, 13406 b have deformable elements 13412 a, 13412b configured to be reversibly deform. In this example, the deformableelements 13412 a, 13412 b are in the form of t-shaped barb members.However, it should be appreciated that the deformable elements 13412 a,13412 b can have any other suitable configurations. For example, theycan be configured as Christmas tree-type, umbrella-like, or any othertypes of deformable elements configured to be used to retain an adjunctmaterial on a jaw as discussed in more detail below.

The jaw 13402 can be configured in many different ways. In the exampleof FIGS. 103 and 104, the jaw 13402 is in the form of a cartridge bodyor cartridge having a plurality of staple cavities 13403 configured toseat staples therein, the staple cavities opening on a tissue-facingsurface 13405 of the cartridge 13402. As shown in FIG. 103, the staplecavities 13403 form three rows on both sides of a cutting elementchannel 13407 extending through a mid-portion of the cartridge 13402along a longitudinal axis 13A2 thereof. It should be appreciated,however, that any suitable number of the staple cavities 13403 can haveany suitable pattern(s) on the tissue-facing surface 13405 of the jaw13402, as the described embodiments are not limited in this respect.

The cartridge 13402 can have suitable features configured to retain anadjunct material thereon. As shown in FIGS. 103 and 104, the cartridge13402 has a first pair of recesses 13414 a, 13414 b formed in thetissue-facing surface 13405 thereof. The recesses of the first pair ofrecesses 13414 a, 13414 b are spaced from opposed edges of thetissue-facing surface 13405 and are disposed on opposed sides of thecutting element channel 13407 extending centrally through the cartridge13402 along the longitudinal axis 13A2 thereof. The first recesses 13414a, 13414 b are formed on a distal portion 13405 d of the tissue-facingsurface 13405 that is free of the staple cavities, as shown in FIGS. 103and 104. In some embodiments, however, the first recesses 13414 a, 13414b can be formed within the area of the tissue-facing surface 13405having the staple cavities formed thereon.

The first recesses 13414 a, 13414 b formed in the tissue-facing surface13405 of the cartridge 13402 can have many different configurations. Inthis example, the first recesses 13414 a, 13414 b can have a generallyoval cross-sectional shape and they can be sized to allow therewithinthe first and second ends 13406 a, 13406 b with the deformable elements13412 a, 13412 b. Although not shown in FIGS. 103 and 104, the innerwalls of the first recesses 13414 a, 13414 b can have a configurationand size that allow the deformable elements 13412 a, 13412 b to be atleast partially deform as they are received within the recesses 13414 a,13414 b and to then return at least in part to their non-deformableconfiguration to thus be retained in the recesses 13414 a, 13414 b.Furthermore, in some implementations, the first recesses 13414 a, 13414b can be formed through the entire thickness of the jaw 13402 such thatthe deformable elements 13412 a, 13412 b return at least in part totheir non-deformable configuration on the side of the jaw 13402 that isopposed to the tissue-facing surface 13405 of the jaw 13402.

The adjunct material 13400 can have many different configurations. Inthe illustrated embodiment, the adjunct material 13400 is generallyrectangular, with its width and length generally corresponding to thewidth and length of the tissue-facing surface 13405 of the cartridge13402. In the illustrated example, the adjunct material 13400 hasfeatures configured to retain it on the cartridge 13402. In particular,the adjunct material 13400 has a second pair of through openings orrecesses 13418 a, 13418 b formed therein. As shown schematically inFIGS. 103 and 104, the second recesses 13418 a, 13418 b are formed atlocations in the adjunct material 13400 that correspond to the locationof the first recesses 13414 a, 13414 b formed in the tissue-facingsurface 13405 of the cartridge 13402. Each of the second recesses 13418a, 13418 b can have a size that is similar to sizes of the firstrecesses 13414 a, 13414 b, or the size of each of the second recesses13418 a, 13418 b can be slightly smaller than that of the first recesses13414 a, 13414 b.

In use, when the adjunct material 13400 is disposed on the tissue-facingsurface 13405 of the cartridge 13402, the adjunct's second recesses13418 a, 13418 b align with the cartridge's first recesses 13414 a,13414 b. In this way, the second recess 13418 a is disposed above andcommunicates with the first recess 13414 a, and the second recess 13418b is disposed above and communicates with the first recess 13414 b. Theretaining filament 13301 is manipulated to cause its first and secondends 13406 a, 13406 b to be pushed through the adjunct's second recesses13418 a, 13418 b and then to be allowed within the second recesses 13418a, 13418 b in the cartridge 13402. The mid-portion 13408 of theretaining filament 13301 is disposed over the adjunct 13400, as shown inFIG. 104. The first and second arm portions 13410 a, 13410 b extendthrough the thickness of the adjunct 13400 and can at least partiallyextend through the body of the cartridge 13402.

FIG. 103 shows the deformable elements 13412 a, 13412 b in theirnatural, non-deformed state. Thus, for example, in the non-deformedstate or configuration of the element 13412 b, its prongs 13413 a, 13413b are perpendicular to a post 13415. The deformable elements 13412 a,13412 b can be resiliently deformable such that, as they are passedthrough the second recesses 13418 a, 13418 b in the adjunct 13400, underthe load applied thereto, they are caused to accept at least partiallynon-deformed state, e.g., the prongs 13413 a, 13413 b of the element13412 b come closer to its post 13415. In such at least partiallyunexpanded configuration, the elements 13412 a, 13412 b are then passedthough the openings of the first recesses 13414 a, 13414 b in the jaw13402, upon which the elements 13412 a, 13412 b return at least in partto their expanded configuration, to be retained within the firstrecesses 13414 a, 13414 b. Thus, in the example of the element 13412 b,the prongs 13413 a, 13413 b move away from the post 13415 to form anacute angle with the post 13415 or to be disposed perpendicular thereto(if they fully return to the expanded configuration). In theimplementations in which the first recesses 13414 a, 13414 b in the jaw13402 are in the form of through openings, the deformable elements 13412a, 13412 b can expand on the surface of the jaw opposite to thetissue-facing surface 13405 thereof. In this way, for example, theprongs 13413 a, 13413 b will be pressed against that surface of the jaw.

The adjunct material 13400 releasably retained on the cartridge 13402can be separated from the cartridge 13402 in different ways. Forexample, a cutting element (e.g., a knife), as it translates through thecutting element channel 13407 formed centrally in the jaw 13402, can cutthe retaining filament 13401 disposed, as shown in FIG. 104, above thechannel 13407.

It should be appreciated that the cartridge 13102 can have otherfeatures for releasably retaining therein the adjunct material 13400.For example, in some embodiments, a proximal end 13405 p of thetissue-facing surface 13405 can include retaining members similar to thefirst recesses 13414 a, 13414 b. In such embodiments, the adjunctmaterial 13400 can also have openings similar to the second recesses13418 a, 13418 b. Additionally or alternatively, other retainingfeatures can be formed on the cartridge and/or on the adjunct.

In some embodiments, an end effector can have two separate adjunctmaterials releasably retained thereon. One (“first”) of the separateadjunct materials can be configured to be disposed on one jaw of the endeffector (e.g., a cartridge body), and another (“second”) adjunctmaterial can be configured to be disposed on another jaw of the endeffector. The first and second adjunct materials have respective firstand second mating features formed at proximal ends thereof. The endeffector has an attachment feature formed at a proximal end thereof andconfigured to mate with at least one the first and second matingfeatures of the first and second adjunct materials.

FIGS. 105 and 106 illustrate an implementation of an end effector 13500having two separate adjunct materials releasably retained thereon. Theend effector 13500 can have first and second jaws configured to clamptissue therebetween, such as a jaw having a cartridge with a pluralityof staple cavities configured to seat staples therein, and another,opposing jaw having an anvil with a plurality of staple forming cavitiesformed on a tissue-facing surface thereof. In this example, only aportion of the end effector 13500 in the form of a jaw having acartridge body 13502 (also partially shown) is illustrated.

The end effector 13500 can be used with any suitable surgicalinstrument, for example, a linear surgical stapler (e.g., stapler 10 inFIG. 1, stapler 50 in FIG. 4, or any other surgical stapler) that issuitable for use with at least one adjunct material. The end effector13500 can be coupled to a distal end of a shaft of the surgical stapler(not shown). The cartridge body 13502 has a plurality of staple cavities13504 that are configured to seat staples therein and that open on atissue-facing surface 13506 of the cartridge body 13502. The cartridgebody 13502 can be in the form of a channel that removably andreplaceably seats a cartridge therein, or the cartridge body 13502 withthe staples can itself be a removable and replaceable unit. Also, insome embodiments, the cartridge body 13502 holding the staples can partof a disposable loading unit removably coupled to an elongate shaft of asurgical instrument.

As mentioned above, the end effector 13500 has first and second adjunctmaterials 13512, 13514 configured to be releasably coupled thereto. Theend effector 13500 has an attachment feature configured to mate with thefirst and second adjunct materials 13512, 13514. Specifically, as shownin FIG. 105, the end effector 13500 has an attachment feature 13508formed at a proximal end 13500 p thereof. In this implementation, theattachment feature 13508 is coupled to a proximal end 13502 of thecartridge body 13502, though in other implementations of the presentsubject matter, the attachment feature 13508 can be coupled to an anvilor to element(s) of the end effector that are not part of the cartridgeor the anvil.

Furthermore, in the described implementation, the attachment feature13508 is in the form of a substantially cylindrical bar 13510 positionedabove the tissue-contacting surface 13506 of the cartridge body 13502and oriented so as to be transverse to a longitudinal axis 13A3 of theend effector 13500. The cylindrical bar 13510 is coupled to a supportmember 13511 so as to be positioned above the tissue-contacting surface13506, as shown in FIG. 105. The cylindrical bar 13510 can be integrallyand/or monolithically formed with the support member 13511, or it can becoupled to the support member 13511 in a suitable member.

The first adjunct material 13512 having proximal and distal ends 13512p, 13512 d is configured to be releasably retained on one jaw of the endeffector 13500, such as, in this example, the cartridge body 13502. Thesecond adjunct material 13514 having proximal and distal ends 13514 p,13514 d is configured to be releasably retained on another, opposed jawof the end effector 13500, such as an anvil which is not shown. Each ofthe first and second adjunct materials 13512, 13514 has a respectivemating feature at the proximal end 13512 p, 13514 p thereof for matingwith the end effector's attachment feature 13508. In particular, asshown in FIG. 105, the first adjunct material 13512 has a first matingfeature in the form of first open-ended loop features 13516 a, 13516 b.Each of the first open-ended loop features 13516 a, 13516 b includes anarm 13515 a, 13515 b and an open-ended loop 13517 a, 13517 b. As shownin FIG. 105, the open-ended loops 13517 a, 13517 b have their gaps oropen ends on the top of the loops such that the open ends face away fromthe cartridge body 13502, in a direction substantially transverse to thelongitudinal axis 13A3 of the end effector 13500 and towards the opposedjaw (not shown). As also shown in FIG. 105, the open-ended loop features13516 a, 13516 b of the first adjunct material 13512 are formed on theproximal end 13512 p such that they are spaced away from opposed edges13513 a, 13513 b of the proximal end 13512 p and are thus formedadjacent to one another and in proximity to a mid-portion of theproximal end 13512 p.

The second adjunct material 13514 has a second mating feature in theform of second open-ended loop features 13518 a, 13518 b. Each of thesecond open-ended loop features 13518 a, 13518 b includes an arm 13521a, 13521 b and an open-ended loop 13523 a, 13523 b. As shown in FIG.105, the open-ended loops 13523 a, 13523 b have their gaps or open endson the side of the loops such that the open ends face away from thecartridge body 13502, in a direction substantially parallel to thelongitudinal axis 13A3 of the end effector 13500. The open-ended loopfeatures 13518 a, 13518 b are formed on the proximal end 13514 p of thesecond adjunct material 13514 such that they are adjacent to opposededges 13519 a, 13519 b of the proximal end 13514 p.

The configurations of the mating features of the first and secondadjunct materials 13512, 13514 allow the mating features to mate withthe attachment feature 13508 as shown in FIG. 106. The open-ended loopsof the first and second open-ended loop features 13516 a, 13516 b, 13518a, 13518 b have circumferences that are slightly undersized relative tocylindrical bar 13510 such that the open-ended loops can slightly deformto encompass the bar 13510. The first and second open-ended loopfeatures 13516 a, 13516 b, 13518 a, 13518 b can be formed from at leastpartially resilient material such that the features can be snapped ontothe bar 13510 through the gaps in the open-ended loops. The non-limitingexamples of the materials include polymers such as, e.g., polydioxanone(PDO), poly(glycerol sebacate) (PGS)/poly(lactic acid) (PLA),poly(glycolic acid) (PGA)/polycaprolactone (PCL), trimethylene carbonate(TMC)/PGA, or any other suitable material or a combination of materials.

Further, the first and second open-ended loop features 13516 a, 13516 b,13518 a, 13518 b are configured to engage the bar 13510 such that thefirst open-ended loop features 13516 a, 13516 b engage the bar 13510 atlocations different from locations at which the second open-ended loopfeatures 13518 a, 13518 b engage the bar 13510. In particular, as shownin FIG. 106, the first open-ended loop features 13516 a, 13516 b engagethe bar 13510 at the locations on the bar 13510 between the locations atwhich the second open-ended loop features 13518 a, 13518 b engage thebar 13510. In this way, both the first and second open-ended loopfeatures 13516 a, 13516 b, 13518 a, 13518 b movably engage the bar 13510to thereby engage the separate first and second adjunct materials 13512,13514 with the end effector 13500. In some embodiments, the open-endedloops can be segmented in such a way that the opposing sides are notdirectly opposite to one another. For example, the loops can bestaggered.

In some implementations of the current subject matter, one or both ofthe first and second adjunct materials 13512, 13514 can have additionalattachment features configured to releasably couple the adjunctmaterials 13512, 13514 with the respective opposed jaws of the endeffector. For example, one or more portions of the second adjunctmaterial 13514 configured to be disposed on the anvil can be releasablycoupled to the anvil using an adhesive material. Other attachmentfeatures can be formed on the second adjunct material 13514 and/or onthe anvil in addition to the second open-ended loop features 13518 a,13518 b. Also, in some implementations, the first adjunct material 13512can be coupled to the cartridge body 13502 using one or more additionalattachment features.

FIG. 107 illustrates another embodiment of an end effector 13600 havingfirst and second adjunct materials 13612, 13614 releasably coupledthereto via respective mating features. FIG. 107 shows only a portion ofthe end effector 13600, a cartridge body 13602, which is configured toreleasably retain thereon the first adjunct material 13612. An opposedjaw, an anvil, which is not shown in FIG. 107, is configured toreleasably retain thereon the second adjunct material 13614.

In this implementation, the cartridge body 13602 has the first adjunctmaterial 13612 releasably coupled thereto. The first adjunct material13612 has a size and shape complementary to a size and shape of atissue-facing surface of the cartridge body 13602 (obscured by theadjunct material 13612), and the first adjunct material 13612 can becoupled to the cartridge body 13602 using adhesive material(s) or inother suitable ways.

In this embodiments, the first and second adjunct materials 13612, 13614have respective mating features that are configured to couple (e.g.,interlock) to one another to thereby couple the first and second adjunctmaterials 13612, 13614 to one another. Thus, the first adjunct material13612 has a slot 13616 formed at a proximal end 13612 p thereof. Thesecond adjunct material 13614, which can have a size and shapecomplementary to a size and shape of a tissue-facing surface of the endeffector's anvil (not shown), has a tab 13618 extending from a proximalend 13614 p thereof and configured to be received within the slot 13616.FIG. 108 shows the tab 13618 of the second adjunct material 13614 matingwith the slot 13616 of the first adjunct material 13612. The tab 13618can have a length such that it engages with the slot 13616 to retain thesecond adjunct material 13614 in engagement with the first adjunctmaterial 13612. Also, in use, the tab 13618, when engaged with the slot13616, can operate as a tissue stop to prevent or reduce tissue frombeing displaced or leaked from the treatment site when the jaws of theend effector 13600 are grasping the tissue.

It should be appreciated that the slot 13616 in the first adjunctmaterial 13612 and the tab 13618 in the second adjunct material 13614are shown by way of example only, as the first and second adjunctmaterials 13612, 13614 can have any other mating features configured tocouple with one another. In some embodiments, such mating features canbe complementary to one another.

In some implementations, the first and second adjunct materials 13612,13614 can be coupled to the respective jaws of the end effector 13600using other additional features. For example, adhesive can be used toreleasably couple the adjunct materials 13612, 13614 to the jaws. Anyother attachment features can be used additionally or alternatively.

In some embodiments, attachment features can be formed on an adjunctmaterial configured to be releasably disposed on a jaw of an endeffector. These embodiments can be used in connection with end effectorshaving gripping features that extend from a shorter side of each staplepocket in a cartridge of the end effector. For example, the grippingfeatures can be implemented in accordance with ECHELON™ Gripping SurfaceTechnology such that each of the staple pockets has opposed extensionfeatures configured to provide a grip that holds tissue in place duringfiring.

FIGS. 109, 110A and 110B illustrate an embodiment of a cartridge 13700of an end effector (not shown) having gripping extensions formed atstaple pockets 13704 in a tissue-contacting surface 13702. As shown inFIGS. 109 and 110B, each staple pocket has extension features formed atopposite sides of the pocket along a longitudinal axis of the pocket.For example, a staple pocket 13706 has first and second extensionfeatures 13706 a, 13706 b formed at opposed sides of the pocket 13706along a longitudinal axis thereof. Some or all of the other staplepockets can be configured in a similar manner. The extension features13706 a, 13706 b of the staple pocket 13706 typically are formedintegrally with the tissue-contacting surface 13702.

The extension features 13706 a, 13706 b of the staple pocket 13706 (aswell as extension features of other staple pockets) can have any of avariety of configurations. For example, as shown in FIG. 110B,illustrating by way of example the staple pocket 13706 in cross-section,the extension features 13706 a, 13706 b can be in the form of slightlycurved features that are also slightly inclined towards a mid-portion ofthe staple pocket 13706. It should be appreciated, however, that theextension features 13706 a, 13706 b can have any other configurationsand that the described techniques are not limited to any particular typeof extension features adjacent to staple pockets.

In the illustrated example, an adjunct material 13708 is configured tobe releasably retained on the tissue-contacting surface 13702 of thecartridge 13700. The adjunct material 13708 can have a plurality ofmating features for releasably mating with the cartridge 13700. Inparticular, in this implementation, the mating features are in the formof openings 13710 formed on the side 13712 of the adjunct material 13708facing the tissue-contacting surface 13702. The openings 13710 areconfigured to mate with the extension features formed on the cartridge13700. For example, openings 13710 a, 13710 b shown in FIG. 109 areconfigured to mate with the extension features 13706 a, 13706 b,respectively, such that the extension features 13706 a, 13706 b arereceived within the openings 13710 a, 13710 b. Thus, the openings 13710can be configured to fit the extension features 13706 a, 13706 btherewithin, such that the size of the openings 13710 corresponds to thesize of the extension features 13706 a, 13706 b. Also, the openings13710 can be spaced from one another in accordance with a distance ofthe extension features 13706 a, 13706 b from one another, as discussedin more detail below.

The openings 13710 can be formed on the adjunct 13708 at predeterminedlocations such that each pair of openings (e.g., the openings 13710 a,13710 b) is configured to be mated with corresponding extension features(e.g., the extension features 13706 a, 13706 b). The adjunct 13708 canhave openings formed thereon that correspond to each of the staplepocket's extension features, or, in some embodiments, only some of theopenings can mate with the extension features, and vice versa. In otherwords, the number of the openings may be different from the number ofextension features.

The openings in the adjunct can be relatively small. For example, in atleast one embodiment, they can have a diameter of about 0.010 inches,though the openings can have another diameter. In some implementations,the openings can be formed in the adjunct at certain distances from oneanother without taking into considerations specific pairs of extensionfeatures to mate with the pairs of openings. In such implementations,for example, when the adjunct is disposed over a cartridge and someforce is applied thereto (e.g., the adjunct is pressed over atissue-contacting surface of the cartridge), all or at least some of theopenings will “find” extensions features to mate with, and vice versa.Thus, the adjunct can have multiple openings at a certain distance fromone another (which can be smaller than a distance between the openingsthat are configured to mate with specific extension features) and atleast some of these openings can mate with the extension features of thecartridge.

As mentioned above, in the example illustrated, the openings 13710 canbe spaced from one another in accordance with a distance of theextension features 13706 a, 13706 b from one another. Furthermore, as inthe example illustrated, the adjunct material 13708 can be made from atleast partially stretchable material such that, when it is placed overthe cartridge 13700 (which can be done with application of some force),one or more portions of the adjunct material 13708 can stretch. Forexample, the portions between at last some of the openings 13710 canstretch so that the openings at opposed sides of the portions are placedin positions for mating with respective extension features.

Thus, as illustrated in FIGS. 110A and 110B, before the adjunct 13708 isplaced on the cartridge 13700, the openings 13710 a, 13710 b (as alsoshown in FIG. 109) are disposed at a distance 13 d 1 from one another.When the adjunct 13708 is caused into engagement with the cartridge13700 when force is applied thereto (via a user's hand or using anyremovable applicator, frame, etc.), the adjunct 13708 is caused tostretch such that the openings 13710 a, 13710 b move further apart fromone another, as shown by arrows 13714 a, 13714 b in FIG. 110B. Inparticular, the openings 13710 a, 13710 b become spaced apart at adistance 13 d 2 that is greater than the distance 13 d 1 (FIG. 110A), asshown in FIG. 110B. In this way, the openings 13710 a, 13710 b becomedisposed at the distance from one another that allows them to mate withthe extension features 13706 a, 13706 b of the staple pocket 13706having a staple 13707 ejectably disposed therein. When the adjunct 13708is caused to engage the tissue-contacting surface 13702 of the cartridge13700, portion(s) of the adjunct 13708, including the portion betweenthe openings 13710 a, 13710 b can be displaced until one or both of theopenings receives the corresponding extension feature therein. In otherwords, the adjunct 13708 can be stretched, until the openings 13710 a,13710 b in the adjunct 13708 engage with the corresponding extensionfeatures 13706 a, 13706 b. Other openings in the adjunct engage theextension features in the cartridge in a similar manner, and the adjunct13708 thus becomes releasably engaged with the cartridge 13700. Inembodiments in which the number of openings in the adjunct is greaterthat the number of extension features, at least some of the openings canengage with the extension features in a similar manner.

End Effector Configured to Mate with Adjunct Materials

In some implementations, an adjunct material is configured to bereleasably retained on a jaw of an end effector for a surgicalinstrument using complementary mating features formed on the jaw and onthe adjunct. In particular, the adjunct material can have discrete orlongitudinal projections formed thereon at least at distal and proximalends of the adjunct material. The projections are configured to bereceived within the complementary recesses formed in a jaw of the endeffector to thereby releasably mate the adjunct material with the jaw.In some embodiments, the end effector can include an attachment featurein the form of a polymer attachment layer that can be used to attach theadjunct material to the jaw.

Furthermore, the end effector includes a removable applicator memberconfigured to apply force to the adjunct material to cause the adjunctmaterial to be releasably retained on the jaw. The applicator member canbe in the form of an applicator or retainer removably coupled to the endeffector, or in the form of a frame-like applicator configured toreleasably hold the adjunct material, or in other forms. Thus, in someimplementations, in use, the applicator member is removably coupled tothe end effector and used to apply force to the adjunct material (and insome embodiments to a polymer attachment layer) to cause the projectionsof the adjunct material (and in some embodiments projections formed onthe polymer attachment layer) to be at least partially received withincorresponding recesses formed in the jaw. In other implementations, aframe-like applicator member holding at least one adjunct material isclamped between the jaws of the end effector. In this way, force isapplied to the applicator member, which causes the applicator member torelease the at least one adjunct material and to transfer the at leastone adjunct material to at least one respective jaw of the end effector.After use, the applicator member can be separated from the end effector.

The described techniques can also employ other ways and structures toreleasably retain an adjunct material on at least one jaw of an endeffector of a surgical instrument.

FIGS. 111-113B illustrate an example of an end effector 14100 configuredto releasably retain an adjunct material on one or both of its first andsecond opposed jaws configured to clamp tissue therebetween, inaccordance with the described techniques. The end effector 14100,partially illustrated in FIGS. 111 and 112, has a first jaw having acartridge body 14102 and a second jaw having an anvil 14104. Thecartridge body 14102 is configured to releasably retain thereon animplantable adjunct material 14106. The end effector 14100 can becoupled to a distal end of a shaft of the surgical instrument (notshown). The end effector 14100 can be used in any suitable surgicalinstrument, for example, a linear surgical stapler (e.g., stapler 10 inFIG. 1, stapler 50 in FIG. 4, or any other surgical stapler) which canbe suitable for use with at least one adjunct.

As shown in FIG. 111, the cartridge body 14102 has a plurality ofstaple-holding cavities 14108 configured to seat staples therein, thestaple-holding cavities 14108 opening on a tissue-facing surface 14110of the cartridge 14102. The staple cavities 14108 form a certain patternon the surface of the cartridge 14102 which corresponds to a pattern ofstaple-forming cavities (obscured in FIG. 111) formed in the anvil14104. The cartridge body 14102, also referred to as a cartridge,includes a cutting element channel 14113 extending between distal andproximal ends 14102 d, 14102 p of the cartridge 14102. The knife channel14113 is configured to receive a cutting element (e.g., a knife) as itmoves distally therethrough. As shown in FIG. 111, the staple cavities14108 can form three rows on both sides of the cutting element channel14113, though it should be appreciated that the staple cavities 14108can form any other patterns on the tissue-facing surface 14110.

The cartridge body 14102 can be in the form of a staple channelconfigured to support a staple cartridge, which can be removably andreplaceably seated within the staple channel. Furthermore, in someembodiments, the cartridge 14102 can be part of a disposable loadingunit coupled distally to a shaft of a surgical instrument.

The end effector 14100 has the implantable adjunct material (or“adjunct”) releasably mounted on one or both of the cartridge 14102 andthe anvil 14104. In the illustrated implementation, the adjunct material14106 releasably retained on the cartridge 14102 is discussed, though itshould be appreciated that the anvil 14104 can also have an adjunctmaterial releasably retained thereon. As shown in FIGS. 111 and 112, theend effector also includes a loading member 14105 configured to applyforce to the adjunct material 14106 to cause the adjunct material 14106to be retained on the cartridge 14102, as discussed in more detailbelow. As also shown in FIGS. 111 and 112, and additionally illustratedin FIGS. 113A-113B, the end effector 14100 can further include a polymerattachment layer 14107 configured to be positioned between the cartridge14102 and the adjunct material 14106, as also discussed in more detailbelow.

In the illustrated implementation, the cartridge 14102 can have at leastone recess formed therein that opens on its tissue-facing surface 14110,with the at least one recess being configured to mate with a respectiveprojection formed in the adjunct 14106. Thus, as shown in FIGS. 111 and112, the cartridge 14102 has at least one first recess 14112 d formed atthe distal end 14102 d thereof and at least one second recess 14112 pformed at the proximal end 14102 p thereof. In the example illustrated,some of the recesses are obscured by the adjunct 14106, and the at leastone first recess 14112 d is in the form of two recesses formed onopposite sides of the cutting element channel 14113. The at least onesecond recess 14112 p is similarly in the form of two recesses formed onopposite sides of the cutting element channel 14113.

The recesses 14112 d, 14112 p formed in the cartridge 14102 can have avariety of different configurations. In the illustrated example, asshown in FIG. 111, each of the recesses is a discrete recess that has agenerally circular top cross-section such that the recess iscylindrical. It should be appreciated, however, that the recesses in theend effector's jaw, such as the cartridge, can have otherconfigurations. For example, the recesses can be square, rectangular,semi-circular (e.g., having a semi-circular or oval shape as viewed fromthe top), and/or they can have any other suitable regular or irregularshapes. Regardless of their specific configuration(s), the recessesformed in the cartridge are configured to receive therein at least aportion of a respective projection formed on an adjunct material oranother member, as discussed below.

As shown in FIG. 112, the adjunct material 14106 has projections thatare complementary to the recesses 14112 d, 14112 p formed in thecartridge 14102 and that are configured to mate with the recesses 14112d, 14112 p to retain the adjunct material 14106 on the cartridge 14102.In the illustrated embodiments, the adjunct material's projection(s) aredisposed at least at proximal and distal ends of the adjunct material.In particular, as shown in FIG. 112, the adjunct material 14106 has atleast one first projection 14116 d formed at the distal end 14106 dthereof and at least one second projection 14116 p formed at theproximal end 14106 p thereof. In the example illustrated, where some ofthe projections are obscured, the at least one first projection 14116 dand the at least one second projection 14116 p are each in the form oftwo respective projections.

The adjunct material 14106 can be formed from any suitable material or acombination of materials, which are discussed above. In someembodiments, the adjunct material 14106 can have a thickness from about0.004 inches to about 0.160 inches. In some embodiments, the adjunctmaterial 14106 can have a thickness from about 0.006 inches to about0.008 inches. The projections 14116 d, 14116 p can have a height orthickness from about 0.005 to about 0.010 inches. In some embodiments,the projections, which can be formed from an elastomeric material, canhave a height in a range from about 0.005 inches to about 0.015 inches,in a range from about 0.003 inches to about 0.006 inches, or a heightthat varies in other ranges. However, in some embodiments, theprojections 14116 d, 14116 p can have a height or thickness up to about0.180 inches or greater.

The locations of the first projections 14116 d and the secondprojections 14116 p formed on the adjunct material 14106 correspond tothe locations of the first recesses 14112 d and the second recesses14112 p formed on the cartridge 14102, respectively. However, in someembodiments, as discussed below, the first distal projections 14116 dcan be closer to one another than the first distal recesses 14112 d, andsimilarly the second proximal projections 14116 p can be closer to oneanother than the second proximal recesses 14112 d. Furthermore, theconfiguration and size of the projections 14116 d, 14116 p correspondsto those of the recesses 14112 d, 14112 p. In this way, the projections14116 d, 14116 p can be caused to be at least partially received withinthe recesses 14112 d, 14112 p, respectively.

For example, as shown in FIG. 111, the projections 14116 d, 14116 pconfigured to be at least partially received in the recesses 14112 d,14112 p are complementary in shape to the recesses such that theprojections 14116 d, 14116 p each have a generally circular topcross-section and are generally cylindrical. Furthermore, in the exampleof FIG. 111, the projections 14116 d, 14116 p are formed in the adjunctmaterial 14106 such they have an open-end channel extending leastpartially therethrough that opens on a side 14121 of the adjunctmaterial 14106 opposed to its side facing the cartridge 14102. Forexample, the projection 14116 d, which can represent all of theprojections formed on the adjunct material 14106, is shown to have achannel 14119 extending therethrough. The channel 14119 can be formedthrough the entire projection or through a portion thereof such that arecess can be formed on the side 14121. Moreover, in someimplementations, the projections 14116 d, 14116 p formed in the adjunctmaterial 14106 may not have a channel extending at least partiallytherethrough.

As mentioned above, in addition to the adjunct material 14106, the endeffector 14100 of the illustrated implementation includes the polymerattachment layer 14107 used in conjunction with the adjunct material14106. In particular, the polymer attachment layer 14107 is disposedbetween the cartridge 14102 and the adjunct material 14106, as shown inFIGS. 111 and 14112. The polymer attachment layer 14107, which can bemade from a pressure-sensitive adhesive or other suitable material, isused as an attachment or retaining feature. For example, non-limitingexamples of materials can include materials described in U.S. Pat. Pub.No. 2016/0278774 entitled “Method of Applying a Buttress to a SurgicalStapler,” filed on Mar. 25, 2015, which is hereby incorporated byreference herein in its entirety. The polymer attachment layer 14107 isconfigured to hold the adjunct material 14106 in a releasable engagementwith the cartridge 14102. Also, the polymer attachment layer 14107 canprovide additional reinforcement to a treatment site. The polymermaterial 14107 can have a size that is the same or approximately thesame to that of the adjunct material 14106 such the entire surface ofthe adjunct material 14106 is disposed on the polymer material 14107.The polymer layer may also serve as a reservoir for medicants such asantimicrobials, chemotherapeutic agents, etc. or be radiopaque forimaging purposes.

As shown in FIG. 112, the polymer attachment layer 14107 includes distaland proximal projections 14117 d, 14117 p facing the cartridge 14102.FIG. 112 also illustrates that the distal and proximal projections 14117d, 14117 p are formed on the polymer material 14107 at locationscorresponding to the locations of the adjunct's projections 14116 d,14116 p, respectively. Thus, the distal projections 14117 d can bespaced from the proximal projections 14117 p along a longitudinal axis14A1 of the polymer attachment layer 14107 by the same distance by whichthe distal projections 14116 d are spaced from the proximal projections14116 p. The projections 14117 d, 14117 p can be configured similarly tothe adjunct's projections 14116 d, 14116 p—for example, the projections14117 d, 14117 p can each optionally have an open-end channel extendingleast partially therethrough (not shown).

Also, the distal and proximal projections 14117 d, 1411′7 p of thepolymer attachment layer 14107 can have a length or diameter, asmeasured along the longitudinal axis 14A1, that is similar to that of alength or diameter of the distal and proximal projections 14116 d, 14116p of the adjunct material 14106. In some embodiments, the polymerattachment layer 14107 can have a thickness from about 0.0005 inches toabout 0.001 inches. The projections 14117 d, 1411′7 p can have a heightor thickness from about 0.005 to about 0.010 inches. In someembodiments, the projections, which can be formed from an elastomericmaterial, can have a height in a range from about 0.005 inches to about0.015 inches, in a range from about 0.003 inches to about 0.006 inches,or a height that varies in other ranges. However, in some embodiments,the projections 14116 d, 14116 p can have a height or thickness up toabout 0.180 inches or greater.

The polymer attachment layer 14107 can be formed from any suitablematerial such as, for example, polydioxanone (PDO), PLA/PGA copolymers,or any other suitable polymeric material(s), including pressuresensitive adhesive(s). Thus, the adjunct material 14106 can bereleasably engaged with the cartridge 14102 via the polymer attachmentlayer 14107. The polymer layer's projections 14117 d, 14117 p can beformed from the same material as the rest of the polymer attachmentlayer 14107. Also, in some embodiments, the distal and proximalprojections 14117 d, 14117 p can be formed from a different materialthan the material forming the polymer attachment layer 14107. Becausethe material forming the polymer attachment layer 14107 is biodegradableand/or bioabsorbable, the polymer attachment layer 14107 can beimplanted to a treatment site together with the adjunct 14106. It shouldbe appreciated that, in some embodiments, the polymer attachment layer14107 may not be present.

As mentioned above, the end effector 14100 can be removably coupled withthe loading member 14105 having distal and proximal projections 14115 d,14115 p and configured to apply force to the adjunct material 14106 tothereby cause the adjunct material 14106 to mate with the end effector14100. In particular, the application of force by the loading member14105 (and thus by the distal and proximal projections 14115 d, 14115 pthereof) to the adjunct material 14106 causes the adjunct material'sprojections 14116 d, 14116 p to be at least partially received in therecesses 14112 d, 14112 p of the cartridge 14102. Also, in embodimentssuch as in the example illustrated in which the polymer attachment layer14107 is disposed between the adjunct material 14106 and thetissue-facing surface 14110 of the cartridge 14102, the application offorce by the loading member 14105 to the adjunct material 14106 and thusto the polymer attachment layer 14107 causes the polymer layer'sprojections 14117 d, 1411′7 p to be at least partially received in therecesses 14112 d, 14112 p of the cartridge 14102. Furthermore, theadjunct material's projections 14116 d, 14116 p can be caused to be atleast partially received within the polymer layer's projections 14117 d,14117 p, respectively, as discussed below.

The distal and proximal projections 14115 d, 14115 p of the loadingmember 14105, each of which can be in the form of two respectiveprojections, can be configured in a number of different ways. Forexample, the distal and proximal projections 14115 d, 14115 p can have alength (measured along a longitudinal axis 14A2 of the loading member14105) that is similar to that of the adjunct material's projections14116 d, 14116 p and the polymer layer's projections 14117 d, 14117 p.The distal and proximal projections 14115 d, 14115 p can have anopen-end channel extending least partially therethrough and opening on aside of the loading member 14105 facing the anvil 14104, as shown inFIG. 111. However, in some implementations, one or more of theprojections 14115 d, 14115 p may not include such channel.

Also, the distal and proximal projections 14115 d, 14115 p of theloading member 14105 can be spaced apart from one another along thelongitudinal axis 14A2 by approximately the same distance as the adjunctmaterial's projections 14116 d, 14116 p and the polymer layer'sprojections 14117 d, 14117 p. In some embodiments, however, the distaland proximal projections 14115 d, 14115 p of the loading member 14105can be configured and/or formed on the loading member 14105 in adifferent way. Furthermore, in some implementations, the loading member14105 may not include the distal and proximal projections 14115 d, 14115p, or the loading member 14105 may include only one projection, or othernumber (e.g., more than two) projections of any suitable configurations.

The loading member 14105 can have a variety of different configurations.For example, the loading member 14105 can be in the form of anapplicator or retainer that can be removably coupled to the end effector14100. For example, in the illustrated implementation, as shown in FIGS.111 and 112, the member 14105 is an elongate, generally rectangularcomponent having a length and width generally corresponding to thelength and width of the tissue-contacting surface of the cartridge14102. The member 14105 also has a distal tongue portion 14120 in theform of a downward bent and a generally flat portion extending distallyfrom the bend. The distal tongue portion 14120 can facilitate grip andcan serve as a lever. In use, the surgeon can hold the distal tongueportion 14120 and apply force thereto in the direction towards thetissue-facing surface 14110 of the cartridge 14102 to thereby cause themember 14105 to apply load to the adjunct material 14106. The distaltongue portion 14120 can be grasped and moved (e.g., moved away from thecartridge body 14102) to remove the loading member 14105 from the endeffector 14100.

Additionally or alternatively, the loading member 14105 can be“preloaded,” or releasably coupled with, the adjunct material 14106 andthe polymer attachment layer 14107 in a suitable manner. When force isapplied to the adjunct material 14106, either by operating the loadingmember 14105, or when the loading member 14105 is clamped between thecartridge and anvil 14102, 14104, the adjunct material 14106, and thepolymer attachment layer 14107 (if present) are transferred to thecartridge 14102. The loading member 14105 can then be removed from theend effector 14100.

The loading member 14105 can be coupled to the end effector 14100 inmany different ways. In the illustrated example, the loading member14105 is coupled to the proximal end 14102 p of the cartridge 14102using one or more suitable features. For example, the loading member14105 can have at a proximal end 14105 p thereof a tab 14118 (FIG. 112)configured to engage the proximal end 14102 p of the cartridge body14102. It should be appreciated, however, that any other suitablefeature(s) can be used to removably couple the member 14105 to thecartridge body 14102. Furthermore, in some implementations, the loadingmember 14105 may not be coupled to the end effector 14100—e.g., asdiscussed above it can be clamped between the end effector's jaws tothereby cause the adjunct material 14106 (and the polymer attachmentlayer 14107, if present) to be transferred to the cartridge 14102.

In some embodiments, the adjunct material 14106 and the polymerattachment layer 14107 can be coupled to the loading member 14105 in asuitable manner before the adjunct material 14106 and the polymerattachment layer 14107 are delivered to the cartridge body 14102.Regardless of its configuration and the way in which it is used to causethe adjunct material to be releasably retained on a jaw of an endeffector (e.g., the cartridge 14102), the loading member 14105 isconfigured to evenly apply force to the surface of the adjunct material14106 such that the adjunct material 14106 becomes attached to the jaw.

In some embodiments, as mentioned above, projections of the adjunctmaterial can be at least partially received within the projections thepolymer layer. FIGS. 113A and 113B demonstrate such an example wherefirst and second projections 14216 a, 14216 b of an adjunct material14206 are at least partially received within first and secondprojections 14217 a, 14217 b of a polymer layer 14207. The adjunctmaterial 14206 and the polymer layer 14207 can be similar, for example,to the adjunct material and polymer layer 14106, 14107 (FIGS. 111 and112), respectively. It should be appreciated that. while FIGS. 111 and112 illustrate the adjunct material's and polymer layer's distal andproximal projections, FIGS. 113A and 113C show, by way of example, onlyrespective pairs of distal projections formed on the adjunct material14206 and the polymer layer 14207. Thus, for example, the first andsecond projections 14216 a, 14216 b of the adjunct material 14206 can besimilar to the at least one distal projection 14116 d of the adjunctmaterial 14106 in FIG. 112. It should be appreciated that the adjunctmaterial 14206 and the polymer layer 14207 can also have respectiveproximal projections, similar, for example, to the at least one proximalprojection 14116 p and at least one proximal projection 14117 p (FIG.112), respectively.

As shown in FIG. 113A, the first and second projections 14216 a, 14216 bof the adjunct material 14206 extend from the top into the first andsecond projections 14217 a, 14217 b of the polymer layer 14207. Theadjunct material 14206 and the polymer layer 14207 can be mated in thisway in a number of different ways. For example, the adjunct material14206 can be preloaded with the polymer layer 14207. Alternatively, theprojections of the adjunct material 14206 can be mated with theprojections of the polymer layer 14207 using the loading member or othercomponent(s) configured to apply force to the adjunct material.

Regardless of the way in which the adjunct material 14206 is mated withthe polymer layer 14207 so as to result in the structure as shown inFIG. 113A, such adjunct material/polymer layer structure can be caused(e.g., using the loading member 14105 or another suitable component) tobe engaged with the jaw of an end effector. For example, FIG. 113Billustrates that force can be applied (shown by arrow 14210) to theadjunct material 14206 mated with the polymer layer 14207 to cause thefirst and second projections 14217 a, 14217 b of polymer layer 14207(and thus the first and second projections 14216 a, 14216 b of theadjunct material 14206 mated therewith) to be engaged with correspondingfirst and second recesses 14212 a, 14212 b formed in a jaw 14202. Thejaw 14202 can be a cartridge body (e.g., cartridge body 14102 in FIGS.111 and 112). However, the jaw 14202 can also be an anvil, as thedescribed techniques can be used to releasably retain an adjunctmaterial on an anvil of the end effector as well.

A distance between the first and second recesses 14212 a, 14212 b formedin the jaw 14202 can be greater than a distance between the first andsecond projections 14217 a, 14217 b of polymer layer 14207 (and thusbetween the first and second projections 14216 a, 14216 b of the adjunctmaterial 14206), prior to mating the polymer layer 14207 and the adjunctmaterial 14206 with the jaw 14202. As a result of the force applied tothe adjunct material 14206 mated with the polymer layer 14207, adistance between the first and second projections 14217 a, 14217 b (andthus between the first and second projections 14216 a, 14216 b) canincrease, as shown in FIG. 113A by arrows 14211. In this way, as theforce is applied to the adjunct material 14216 and its thickness thusdecreases, the projections of the polymer layer 14207 and of the adjunctmaterial 14206 “find” the first and second recesses 14212 a, 14212 bformed in the jaw 14202 to thereby releasably mate the adjunct material14206 with the jaw 14202.

Projections formed on an adjunct material in accordance with thedescribed embodiments can have various configurations. For example, insome embodiments, the projections can be longitudinal projections formedon opposed sides of the adjunct material. The longitudinal projectionsformed on the adjunct material can be configured to be mated withcomplementary features (e.g., recesses) formed on a jaw of an endeffector.

FIGS. 114-116 illustrate an embodiment of an end effector 14300 having acartridge 14302 and an anvil 14304, at least one of which can beconfigured to be releasably mated with an adjunct material havinglongitudinal projections. As shown in FIG. 114, the cartridge 14302 hasa plurality of staple cavities 14308 configured to seat staples therein,the staple cavities formed on a tissue-facing surface 14310 of thecartridge 14302. The anvil 14304 of the end effector 14300, shown inFIG. 116, has a plurality of staple forming cavities (not shown) formedon a tissue-facing surface 14314 thereof.

In the illustrated implementation, the end effector 14300 can have anadjunct material releasably retained on one or both of the jaws 14302,14304. Thus, as shown in FIG. 114, an adjunct material 14306 can bereleasably mated with the cartridge 14302. The adjunct material 14306has a first longitudinal projection 14316 a formed on one side 14315 aof the adjunct material 14306 and a second longitudinal projection 14316b formed on another, opposite side 14315 b of the adjunct material14306. As shown, the first and second longitudinal projections 14316 a,14316 b extend between distal and proximal ends 14306 d, 14306 p of theadjunct material 14306.

The first and second longitudinal projections 14316 a, 14316 b of theadjunct material 14306 are configured to mate with respective first andsecond complementary recesses 14312 a, 14312 b formed in thetissue-facing surface 14310 of the cartridge 14302. As shown in FIG.114, the first and second longitudinal recesses 14312 a, 14312 b extendalong a longitudinal axis 14A3 of the cartridge 14302, are formed onopposed sides of a cutting element channel 14313, and are each adjacentto opposed sides 14311 a, 14311 b of the tissue-facing surface 14310.

The longitudinal projections 14316 a, 14316 b formed on the adjunctmaterial 14306 can have a number of different configurations. Forexample, the first and second longitudinal projections 14316 a, 14316 bof the adjunct material 14306 have mating features 14318 a, 14318 bformed thereon that are configured to be at received within thecorresponding recesses 14312 a, 14312 b. In this example, the matingfeatures 14318 a, 14318 b are in the form of arrows facing towards therecesses 14312 a, 14312 b formed in the cartridge 14302.

The longitudinal projections 14316 a, 14316 b can be formed from atleast partially flexible and/or deformable material such that, as theprojections 14316 a, 14316 b are received within the correspondingrecesses 14312 a, 14312 b, the projections 14316 a, 14316 b contract tofit into the recesses and, once in the recesses, expand to be fittinglyreceived within the recesses. Thus, the arrow-shaped mating features14318 a, 14318 b extending from the adjunct material's longitudinalprojections 14316 a, 14316 b can have a width that is greater than thatof the respective recesses 14312 a, 14312 b. When the mating features14318 a, 14318 b are forced into the recesses 14312 a, 14312 b, they canfirst be caused to contract as they are forced into the recesses, wherethey then expand to be releasably retained therein. It should beappreciated that the arrow-shaped mating features 14318 a, 14318 b areshown by way of example only, and the mating features formed on theprojections can have any suitable configuration. For example, the matingfeatures can be C-shaped, J-shaped, or they can have any otherconfiguration(s), including different configurations.

As shown in FIG. 116, an adjunct material 14320 configured to bereleasably retained on the anvil 14304 can have first and secondlongitudinal projections 14322 a, 14322 b, which can be similar to thelongitudinal projections 14316 a, 14316 b formed on the adjunct material14306 configured to be releasably retained on the cartridge 14302. Forexample, similar to the cartridge 14302, the anvil 14304 can havelongitudinal recesses formed therein that are configured to receivetherein the longitudinal projections 14322 a, 14322 b.

One or both of the adjunct materials 14306, 14320 can be releasablyretained on the jaws 14302, 14304, respectively, using an applicatormember 14305 shown in FIG. 115. The applicator member 14305 can be inthe form of a frame-like holder configured to releasably retain one orboth of the adjunct materials 14306, 14320. In the illustrated example,the applicator member 14305 is in the form of first (e.g., bottom) andsecond (e.g., top) generally rectangular housings 14324, 14326 coupledto one another as shown in FIG. 115. As also shown in FIG. 115, thefirst and second housing 14324, 14326 can encompass edges of the longsides of the adjunct materials 14306, 14320 disposed within theapplicator member 14305. In other words, the applicator member 14305 canbe in the shape of a generally rectangular frame following an outerperimeter of at least two sides (e.g., long sides) of one or two adjunctmaterials. In particular, as shown in FIG. 115, the applicator member14305 encompasses at least in part the portions of the adjunct materials14306, 14320 having first and second longitudinal projections 14316 a,14316 b, and 14322 a, 14322 b, respectively, extending therefrom. Therest of the surface area of the adjunct materials 14306, 14320 may benot encompassed by the applicator member 14305, as shown in FIG. 115.The adjunct material 14320 to be retained on the anvil is disposed overthe adjunct material 14306 to be retained on the cartridge. It should beappreciated that the adjunct materials 14306, 14320 and the first andsecond housings 14324, 14326 of the applicator member 14305 encompassingthem can be symmetrical. Thus, either of the adjunct materials 14306,14320 can be applied to the anvil or the cartridge.

The applicator member 14305 can be formed from any suitable material(e.g., plastic), and its walls can be relatively thin and it can bedisposable. In use, to transfer the adjunct materials 14306, 14320 tothe cartridge and anvil 14302, 14304, respectively, the cartridge andanvil 14302, 14304 can be clamped over the applicator member 14305. Inthis way, force applied by the jaws 14302, 14304 causes the adjunctmaterials 14306, 14320 to separate from the applicator member 14305 andto be engaged with the jaws 14302, 14304. In particular, in thisexample, as force is applied to the applicator member 14305 by the jaws14302, 14304 of the end effector 14300, the longitudinal projections14316 a, 14316 b formed in the adjunct material 14306 mate with therecesses 14312 a, 14312 b in the cartridge 14302, and, similarly, thelongitudinal projections 14322 a, 14322 b formed in the adjunct material14320 mate with the complementary recesses (not shown) in the anvil14304.

After the adjunct materials 14306, 14320 are transferred to thecartridge and anvil 14302, 14304, the cartridge and anvil 14302, 14304can be opened and the applicator member 14305 can be separated from theend effector 14300. The end effector 14300 having its cartridge andanvil 14302, 14304 thus mated with the adjunct materials 14306, 14320,as shown in FIG. 116, can then be used as desired in a surgicalprocedure.

It should be appreciated that the applicator member 14305 is shown toreleasably retain both of the adjunct materials 14306, 14320 by way ofexample only, as the applicator member 14305 or a similar componentconfigured to releasably hold at least one adjunct material can be usedto transfer an adjunct material only to an end effector's anvil or anend effector's cartridge.

In some embodiments, at least one projection formed on the adjunctmaterial can be in the form of a plurality of discrete projectionsformed from an at least partially flowable or bendable material that hasa changeable configuration. When a suitable applicator applies force tothe adjunct material to cause each of the discrete projections to be atleast partially received within a corresponding recess in a jaw of anend effector, the configuration of each of the discrete projections thatis at least partially received within the corresponding recess changesto conform to a configuration of the corresponding recess. The discreteprojections are configured to separate from the adjunct material andremain within the recesses in the jaw after the staples are formedagainst the staple forming cavities to apply the adjunct material to atissue clamped between the end effector's jaws.

FIGS. 117-119 illustrate anther embodiment of an end effector 14400having a cartridge 14402 and an anvil 14404, at least one of which canhave an adjunct material releasably retained thereon that is hasprojections made from an at least partially flowable material. Theprojections can also be formed from at least partially bendable,free-flowing, or waxy materials. In other words, the material from whichthe projections are formed can be deformable in various ways. Forexample, they can be made from polymers/elastomers may deform or bendand still retain memory of their original shape.

In this example, as shown in FIG. 117, both the cartridge 14402 and theanvil 14404 can have respective adjunct materials 14406, 14420 to bereleasably retained thereon. As shown in FIG. 117, the adjunct material14406 releasably retained on a tissue-facing surface 14410 of thecartridge 14402 has a plurality of discrete projections 14416 configuredto be releasably mated with recesses 14412 formed in the tissue-facingsurface 14510. As shown in FIG. 117, the discrete projections 14416 areformed along a longitudinal axis 14A4 of the adjunct 14406. It should beappreciated that the projections 14416 and recesses 14412 do not need tobe evenly spaced and, in some embodiments, they can be disposed atvaried distances from one another. The locations and number of theprojections 14416 and recesses 14412 can be selected based on a desiredmanner of attaching the adjunct material to the end effector's jaw.Accordingly, the seven evenly spaced projections 14416 are shown in FIG.117 by way of example only, as suitable number of projections can beformed, and the projections can be formed asymmetrically and unevenlyspaced with respect to one another.

The adjunct material 14420 releasably retained on a tissue-facingsurface 14411 of the anvil 14402 also has a plurality of discreteprojections 14421 configured to be releasably mated with recesses 14434formed in the tissue-facing surface 14411. It should be appreciated thateach of the discrete projections 14416, 14421 can be formed such that itspans the entirety of, or only a portion of, the width of the respectivejaw. Also, in some implementations, each of the discrete projections14416, 14421 can be in the form of two projections formed on opposedsides of the tissue-facing surface of the jaw, although only one of suchprojections is shown in FIG. 117.

In this example, the discrete projections 14416 formed on the adjunctmaterial 14406 and the discrete projections 14421 formed on the adjunctmaterial 14420 have a generally rectangular shape, as shown in FIG. 117(where the projections of the anvil's adjunct material 14420 are shownpartially separated from the anvil 14404). The discrete projections14416, 14421 can be formed from an at least partially flowable materialand can have a changeable configuration such that, when each of thediscrete projections is at least partially received within acorresponding recess in the jaw, the configuration of each discreteprojection changes to conform to a configuration of the correspondingrecess. The at least partially flowable material can be any suitablematerial or a combination of materials. Examples of the materials caninclude a suitable polymeric material, elastomeric material (e.g.,silicone), wax, and any other material(s). For example, collagen,gelatin hyaluronic acid, sodium alginate, or any other hydrogels can beused. Also, non-limiting examples of materials can include materialsdescribed in U.S. Pat. Pub. No. 2016/0278774 entitled “Method ofApplying a Buttress to a Surgical Stapler,” filed on Mar. 25, 2015,which is hereby incorporated by reference herein in its entirety.

In some embodiments, a more rigid polymer/elastomer can be used that canbe perforated/slitted at the end, such that it frays outward into aT-slot pocket, rather than deforming in bulk, which would require amaterial with very low shear-resistance. In some embodiments, a materialfrom which the adjunct is formed can be used to fill out the recess onits own. This may be possible with non-woven fabrics having fibers thatareable to slide/shear relative to each other.

Accordingly, in the illustrated implementation, each of the generallyrectangular projections 14421 formed on the adjunct material 14420 to bereleasably retained on the anvil 14404, “flows” into, or conforms, tothe configuration of each of the recesses 14434, as shown in FIG. 117.As also shown in FIG. 117, the projections 14416 of the adjunct 14406(which can also be generally rectangular projections) “flow” into theT-shaped recesses 14412 formed in the cartridge 14402 to thus conform tothe shape of the recesses 14412.

The adjunct materials 14406, 14420 can be transferred to the cartridgeand anvil 14402, 14404 using an applicator member 14405 shown in FIG.119, which can be similar to applicator member 14305 (FIG. 115). Thus,as shown in FIG. 119, the applicator member 14405 can be a frame-likeholder having first and second portions 14424, 14426 releasably holdingthe adjunct materials 14406, 14420. To transfer the adjunct materials14406, 14420 from the applicator member 14405 to the end effector 14400,the jaws 14402, 14404 can be clamped upon the applicator member 14405,which causes the adjunct materials 14406, 14420 to be mated with thecartridge and anvil 14402, 14404, respectively. In particular, asdiscussed above, the projections, on the adjunct materials 14406, 14420are received in the recesses 14412, 14434 in the cartridge and anvil14402, 14404 so that the projections (which are formed from at leastpartially flowable material) change their configuration to fill in therecesses and thus adopt the shape of the recesses. Similar to theapplicator member 14305 (FIG. 115), after the applicator member 14405 isused to transfer the adjunct materials 14406, 14420 to the endeffector's jaws, the applicator member 14405 can be separated from theend effector 14400.

During a surgical procedure, as shown in FIG. 118, a tissue 14T isclamped between the cartridge 14402 and anvil 14404 of the end effector14400 and staples 14409 are formed against the staple forming cavitiesof the anvil 14404. The ejection of the staples from the staple-holdingcavities opening on the tissue-facing surface 14410 of the cartridge14402 causes the adjunct materials 14406, 14420 to be released fromengagement with the cartridge 14402 and anvil 14404 and to be applied toopposed sides of the tissue 14T, as also shown in FIG. 118. As furthershown in FIG. 118, the discrete projections 14416, 14421 separate fromthe adjunct materials 14406, 14420 applied to the tissue 14T and remainwithin the recesses 14412, 14434, respectively. Such embodiments can beemployed in implementations where, for example, the end effector 14400is part of a disposable loading unit configured to be coupled distallyto a surgical tool and that is configured to be disposed after use.

In some embodiments, an adjunct material configured to be releasablyretained on a jaw of an end effector can be formed from at leastpartially expandable or stretchable material and/or in the form of afilm. The jaw, such as an anvil or a cartridge, can have one or morerecesses formed therein that are configured to receive portions of theadjunct material. An applicator member, such as, e.g., loading member14305 in FIG. 115, applicator member 14405 in FIG. 119, or a memberhaving any other configuration that has projections formed thereon, canbe used to mate the adjunct material with the jaw. For example, when theapplicator member is used to apply force to the adjunct material, theprojections formed on the applicator member cause portions of theadjunct material to be releasably received within the one or morerecesses formed in the jaw.

FIGS. 120-122 illustrate one example of an implementation of an adjunctmaterial 14506 configured to be mated with a jaw 14500 of an endeffector of a surgical instrument. In this example, the jaw 14500 isshown generally as a jaw that can be either a cartridge or an anvil.Regardless of its particular configuration, the jaw 14500 can haverecesses 14503 formed in a tissue-facing surface 14510 thereof. Itshould be appreciated that the recesses 14503 can be formed at anylocations within tissue-facing surface 14510. Also, the six recesses14503 are shown in FIG. 120 for illustrating purposes only, as anysuitable number of recesses 14503 (e.g., less than six or greater thansix) can be formed on the jaw. Also, the recesses 14503 do not need tobe evenly spaced and, in some embodiments, they can be disposed atvaried distances from one another. The locations and number of therecesses 14503 can be selected based on a desired manner of attachingthe adjunct material to the end effector's jaw.

For example, the recesses 14503 can be formed in the area of thetissue-facing surface 14510 occupied by staple-forming cavities (if thejaw 14500 is an anvil) or by staple-holding cavities or pockets (if thejaw 14500 is a cartridge). As another example, one or more of therecesses 14503 can be formed in area(s) of the tissue-facing surface14510 that does not have the staple-forming cavities or thestaple-holding pockets. For example, in one embodiment, one or morerecesses can be formed at a distal end of the jaw 14500 outside of thearea having the staple-forming cavities or the staple-holding pockets,and one or more recesses can be formed at a proximal end of the jaw14500 outside of the area having the staple-forming cavities or thestaple-holding pockets. Furthermore, in some implementations, one ormore of the recesses 14503 can be the staple-forming cavities or thestaple-holding pockets.

The recesses 14503 are shown by way of example only as having agenerally circular cross-section. However, the recesses 14503 can haveother suitable shapes, as the described embodiments are not limited inthis respect. One or more of the recesses 14503 can have features thatfacilitate their ability to retain a portion of the adjunct materialtherein. For example, as shown in FIG. 121, the recess 14503 can haveretaining features 14512 a, 14512 b that can be in the form of hooks,teeth, rings, barbs, or retaining elements having any otherconfiguration. It should be appreciated that one or more of theretaining features can be formed, or the recesses 14503 can be free ofany additional features.

Regardless of the way in which the recesses 14503 are formed in the jaw14500, each recess (e.g., the recess 14503 shown in FIG. 121) isconfigured to receive therein a corresponding projection or post 14515formed on an applicator member 14505. The applicator member 14505,having one or more posts (one of which is shown in FIGS. 121 and 122),can have any suitable configuration that enables force to be applied bythe applicator member 14505 to the adjunct material 14506. As mentionedabove, the adjunct material 14506 can be formed from an at leastpartially stretchable material. Thus, as shown in FIG. 122, when forceis applied by or to the applicator member 14505 (as shown by arrow14511), the applicator member 14505 is brought in proximity to thetissue-facing surface 14510 such that the post 14515 is at leastpartially received within the recess 14503. As a result, the post 14515pushes a portion 14508 of the adjunct material 14506 into the recess14503, as also shown in FIG. 122. In this example, the retainingfeatures 14512 a, 14512 b extending from the inner walls of the recess14503 facilitate retention of the portion 14508 of the adjunct material14506 within the recess 14503.

Other recesses formed in the jaw 14500 can similarly receive at leastpartially therein posts formed on the applicator member 14505 that thuspush portions of the adjunct material 14506 into the recesses. In thisway, the adjunct material 14506 becomes releasably mated with the jaw14500.

The number and locations of the posts, such as the post 14515, formed onthe applicator member 14505 can correspond to those of the recesses14503 in the jaw 14500. Thus, each of the recesses 14503 can receivetherein a portion of the adjunct material pushed into the recess using acorresponding post. In other implementations, however, only some of therecesses can receive corresponding posts therein.

The post 14515, representing just one example of the multiple posts thatcan extend from the applicator member 14505, is shown as a generallycylindrical element by way of example only, as the post 14515 can haveother configurations. For example, the post 14515 can be mushroom-shaped(e.g., shaped as a “reversed mushroom”) or it can have a generallyrectangular, square, or otherwise shaped cross-section. The size of thepost 14515 can be selected such that it fits with clearance within therecess 14503 and pushes the portion 14508 of the adjunct material 14506into the recess 14503 in a manner that allows retaining that portion14508 in the recess 14503, as shown in FIG. 122. The portion 14508 canbe retained in the recess 14503 using the retaining features 14512 a,14512 b as shown in FIGS. 121 and 122, or any other type(s) of retainingfeatures.

After the adjunct material 14506 is mated with the jaw 14500 using theapplicator member 14505, the applicator member 14505 is removed, whereasthe adjunct material portion 14508 remains in the recess 14503. When theadjunct material 14506 is separated from the jaw 14500 to be transferredto a tissue at a treatment site (e.g., when staples are ejected from thejaw's cartridge), the adjunct material portion 14508 is caused to exitthe recess 14503.

In the illustrated example, the adjunct material 14506, which can be inthe form or a film and/or at least partially stretchable member, can begenerally rectangular or it can have other configurations. The size ofthe adjunct material 14506 can be such that, when its portions (e.g.,the portion 14508 in FIGS. 121 and 122) are mated with the jaw 14500,the adjunct material 14506 still covers a desired area of thetissue-facing surface 14510 of the jaw 14500. In other words, theadjunct material 14506 can be oversized relative to a size of thetissue-facing surface 14510 of the jaw 14500. Also, even though someextra material becomes available after the adjunct material's portionsare released from the recesses in the jaw, this does not affect theability of the adjunct material 14506 to reinforce and/or treat a sitein a patient's body.

In some embodiments, an adjunct material can be releasably retained on ajaw of an end effector using a material that can change itsconfiguration when heat is applied thereto. FIGS. 123 and 124 illustratean embodiment of an end effector 14600 having a cartridge body 14602 andan anvil 14604, which can have an adjunct material 14606 configured tobe retained on at least one of the cartridge body and anvil 14602, 14604using an attachment layer 14607. In particular, in the exampleillustrated, the attachment layer 14607 can be used to couple theadjunct material 14606 to the cartridge body 14602, as discussed in moredetail below.

As shown in FIG. 123, a tissue-facing surface 14610 of the cartridgebody 14602 can have recesses 14612 a, 14612 b disposed outside of thearea of the cartridge body 14602 having staple-holding pockets 14608.The two recesses 14612 a, 14612 b formed at a distal end 14602 d of thecartridge body 14602 are shown, and a proximal end 14602 p of thecartridge body 14602 can have a similar pair of recesses. The recesses14612 a, 14612 b are disposed at opposed sides of a cutting-elementchannel 14613 in the cartridge body 14602, though the recesses 14612 a,14612 b can be disposed at other areas of the tissue-facing surface14610 of the cartridge body 14602.

As shown in FIG. 123, the adjunct material 14606 can have retainingfeatures 14616 a, 14616 b formed at a distal end 14606 d thereof, andsimilar retaining features 14616 c, 14616 d formed at a proximal end14606 p thereof. In the illustrated implementation, the retainingfeatures 14616 a, 14616 b, 14616 c, 14616 d are in the form ofcupcake-like depressions in the adjunct material 14606 extending towardsthe cartridge body 14602 and opening on a side of the adjunct material14606 opposite to its side facing the cartridge body 14602. It should beappreciated, however, that the retaining features 14616 a, 14616 b,14616 c, 14616 d can have any other shapes, and that the number of theretaining features can be different from four (e.g., less than four orgreater than four). Furthermore, as in the example illustrated, theretaining features 14616 a, 14616 b, 14616 c, 14616 d can be formed asclosed depressions in the adjunct material 14606, or they can beopen-ended features opening into the cartridge's recesses when theadjunct is mated therewith.

The distal retaining features 14616 a, 14616 b are configured to bereceived within the distal recesses 14612 a, 14612 b in the cartridgebody 14602. In a similar manner, the proximal retaining features 14616c, 14616 d of the adjunct material 14606 are configured to be receivedwithin the proximal recesses formed in the cartridge body 14602, whichare obscured in FIG. 123.

The attachment layer 14607, which can be formed from a suitable heatmeltable material, can be used to attach the adjunct material 14606 tothe cartridge body 14602. For example, to releasably attach the adjunctmaterial 14606 to the cartridge body 14602, the adjunct material 14606,which can have the attachment layer 14607 coupled thereto in a suitablemanner, can be disposed on the tissue-facing surface 14610 of thecartridge body 14602. The attachment layer 14607 can be coupled to theadjunct material 14606 or it can be disposed over the adjunct material14606 such that the adjunct material 14606 is located between thetissue-facing surface 14610 of the cartridge body 14602 and theattachment layer 14607. Regardless of the way in which the attachmentlayer 14607 is associated with the adjunct material 14606, the adjunctmaterial 14606 is disposed over the cartridge body 14602 such that theretaining features 14616 a, 14616 b, 14616 c, 14616 d are receivedwithin the respective recesses formed in the cartridge body 14602. Forexample, the retaining features 14616 a, 14616 b are received within therecesses 14612 a, 14612 b.

A suitable device can then be used to apply heat to the attachment layer14607 such that at least some of its portions melt and the attachmentlayer's material flows into the retaining features 14616 a, 14616 b,14616 c, 14616 d in the adjunct material 14606 that, in turn, at leastpartially seat within respective recesses formed in the cartridge body14602. In this way, the material of the attachment layer 14607 depositedwithin each of the retaining features 14616 a, 14616 b, 14616 c, 14616 dof the adjunct material 14606 mates the adjunct material 14606 with thecartridge body 14602. FIG. 124 illustrates by way of example a recess14612′ in the cartridge body 14602, which can be representative of anyof the recesses (e.g., 14612 a, 14612 b or others) that can be formed inthe cartridge body 14602. As shown in FIG. 124, the recess 14612′ canseat therein a respective retaining feature 14616′ (e.g., any of theretaining features 14616 a, 14616 b, 14616 c, 14616 d) that in turn, islined with the material of the attachment layer 14607.

The attachment layer 14607 can be formed from any suitable bioabsorbableand/or biodegradable material. Non-limiting examples of the materialinclude polydioxanone (PDO), lactide/glycolide copolymers,poly-L-lactide, poly-L-lactide-co-D,L-lactide,poly-L-lactide-co-glycolide, poly-4-hydroxybutrate, polycaprolactone,poly lactide-co-glycolide), Poly-L-lactide. Exemplary materials are alsodisclosed in U.S. patent application Ser. No. 14/871,195, entitled“Compressible Adjunct Assemblies with Attachment Layers” and Ser. No.14/871,087, entitled “Implantable Adjunct Comprising Bonded Layers.”

Heat of a suitable temperature such as, for example, between 80 C° and120 C°, can be applied to the end effector 14600 in any of various ways.Though, other ranges can be used as well, including higher temperatures.For example, a suitable heater device (e.g., an infrared (IR) heater,ultraviolet (UV) heater, resistive heater, etc.) can be used.

In some implementations, the adjunct material 14606 and the attachmentlayer 14607 can be coupled to the jaw of the end effector 14600, such asthe cartridge body 14602, using an applicator member (not shown)configured to apply the adjunct material 14606 with the attachment layer14607 to an end effector's jaw. The applicator member can be similar,e.g., to the applicator member 14305 (FIG. 115), but can also beequipped with a heating element (e.g., a resistive wire element, UVelement, IR element, etc.). Similar to the applicator member 14305, theheat-applying applicator member can releasably hold the adjunct material14606 and the attachment layer 14607. Regardless of the specific way inwhich the applicator member is configured to generate heat, in use, theapplicator member can be clamped between the jaws 14602, 14604 of theend effector 14600 and activated to generate heat to thus melt at leastportions of the attachment layer 14607. After the attachment layer 14607is received within the retaining features of the adjunct material 14606(e.g., as shown in FIG. 124), the jaws 14602, 14604 can be open and theapplicator member can be separated from the end effector 14600 whileleaving the adjunct material 14606 and the attachment layer 14607 matedwith the end effector 14600 (in this example, with the cartridge body14602).

It should be appreciated that, additionally or alternatively, an adjunctmaterial can be configured to be releasably mated with an anvil in amanner similar to that shown in FIGS. 123 and 124.

In the embodiments described herein, an adjunct material for use with anend effector of a surgical instrument is provided that has at least oneprojection configured to mate with a corresponding at least one recessformed in the end effector. However, in other embodiments, an adjunctmaterial can be releasably retained on a jaw of an end effector usingrecesses formed in the adjunct material that are configured to mate withcorresponding projections formed on the jaw.

FIGS. 125-127 illustrate an embodiment of an end effector 14700 having acartridge 14702 and an anvil 14704, at least one of which can beconfigured to be releasably mated with an adjunct material havinglongitudinal channels or recesses. In this embodiment, the end effector14700 has a cartridge 14702 and an anvil 14704 having any suitableconfigurations, at least one of which can be configured to be releasablymated with an adjunct material having longitudinal recesses. Forexample, as shown, the end effector 14700 can have adjunct materialsreleasably retained on both of the jaws 14702, 14704. Thus, as shown inFIG. 125, an adjunct material 14706 can be releasably mated with thecartridge 14702. The adjunct material 14706 has a first longitudinalrecess 14717 a formed on one side of the adjunct material 14706 and asecond longitudinal recess 14717 b formed on another, opposite side ofthe adjunct material 14706. As shown, the first and second longitudinalrecesses 14717 a, 14717 extend between distal and proximal ends 14706 d,14706 p of the adjunct material 14706.

The first and second longitudinal recesses 14717 a, 14717 b of theadjunct material 14706 are configured to mate with respective first andsecond complementary projections 14715 a, 14715 b formed on atissue-facing surface 14710 of the cartridge 14702. The projections14715 a, 14715 b can have mating features 14718 a, 14718 b formedthereon that are configured to mate with the corresponding recesses14717 a, 14717 b in the adjunct material 14706. In this example, themating features 14718 a, 14718 b are in the form of arrows facingtowards the adjunct material 14706, as shown in FIGS. 125-127. It shouldbe appreciated that the arrow-shaped mating features 14318 a, 14318 bare shown by way of example only, and the mating features formed on theprojections can have any suitable configuration. For example, the matingfeatures can be C-shaped, J-shaped, or they can have any otherconfiguration(s), including different configurations.

The longitudinal recesses 14717 a, 14717 b formed in the adjunctmaterial 14706 can have a number of different configurations. Forexample, the first and second longitudinal recesses 14717 a, 14717 b canhave a shape that is complementary to that of the first and secondprojections 14715 a, 14715 b. In this way, as in the exampleillustrated, at least a portion of each of the first and secondlongitudinal recesses 14717 a, 14717 b can be arrow-shaped. However, therecesses 14717 a, 14717 b can have any other suitable configuration(s).

The longitudinal projections 14715 a, 14715 b can be formed from atleast partially flexible and/or deformable material such that, as theprojections 14715 a, 14715 b are received within the correspondingrecesses 14717 a, 14717 b in the adjunct material 14706, the projections14715 a, 14715 b are contracted to fit into the recesses and, once inthe recesses, are then expanded to be fittingly received within therecesses.

As shown in FIG. 127, an adjunct material 14720 configured to bereleasably retained on the anvil 14704 can also have first and secondlongitudinal recesses 14723 a, 14723 b, which can similar to thelongitudinal recesses 14717 a, 14717 b formed on the adjunct material14706 configured to be releasably retained on the cartridge 14702. Forexample, similar to the cartridge 14702, the anvil 14704 can havelongitudinal projections formed therein that are configured to bereceived within the longitudinal recesses 14723 a, 14723 b. Similar tothe example shown in FIGS. 114-116, one or both of the adjunct materials14706, 14720 can be releasably retained on the jaws 14702, 14704,respectively, using an applicator member 14705 shown in FIG. 126. Theapplicator member 14705, which can releasably retain therein the adjunctmaterials 14706, 14720, can be similar to the applicator member 14305(FIG. 115) and is therefore not described in detail herein.

It should be appreciated that the adjunct materials described herein caninclude one or more medicants which can be releasably incorporated intoor associated with adjuncts in many different ways. Also, the adjunctmaterials can have various other features in addition to the featuresdescribed herein.

Methods and Devices for Delivering and Securing Adjunct Materials to aTreatment Site

FIG. 128A illustrates one embodiment for depositing a flowable adjunctprecursor 15500 upon a surface of a tissue 15502 by an applicator 15504.As shown, the applicator 15504 is positioned adjacent to the tissue15502 and activated to cause the adjunct precursor 15500 to flow fromthe applicator 15504 to the tissue 15502 for deposition at the treatmentsite. The viscosity of the adjunct precursor 15500 can be low enough tofacilitate flow from the applicator 15504 to the tissue 15502 and highenough to inhibit substantial flow once deposited upon the tissue 15502.Additionally, the rheology of the adjunct precursor 15500 can beselected to provide a shear thinning effect. As an example, the adjunctprecursor 15500 can exhibit a lower viscosity during application due theshear generated and exhibit a relatively higher viscosity once applieddue to the near absence of shear.

The adjunct precursor 15500 can be applied to one or more surfaces ofthe tissue 15502. In one aspect, the adjunct precursor 15500 can beapplied to opposed surfaces of the tissue 15502 at approximately thesame location. In another aspect, not shown, the adjunct precursor 15500can be applied to a first surface of the tissue 15502 and a solidadjunct, different from the adjunct precursor 15500, can be applied to asecond surface of the tissue 15502 opposite the first surface of thetissue 15502.

Embodiments of the applicator 15504 can take various forms. Asillustrated in FIG. 128A, in one embodiment, the applicator 15504 caninclude a tubular shaft in fluid communication with a reservoir (notshown) of the adjunct precursor 15500. Under the influence of pressure,the adjunct precursor 15500 is urged from a distal end of the applicator15504 and onto the surface of the tissue 15502. A person skilled in theart will appreciate that the applicator can adopt other configurationssuitable for deposition of the adjunct precursor 15500 upon the tissue15502. As illustrated in FIG. 128B, in another embodiment, an applicator15506 can include a brush that contains the adjunct precursor 15500(e.g., within bristles 15508 of the brush).

The adjunct precursor 15500 can be configured to solidify afterdeposition upon the tissue 15502 to form a solid adjunct. Solidificationof the adjunct precursor 15500 to form the solid adjunct can beaccomplished using various techniques, such as moistening the adjunctprecursor, heating or cooling the adjunct precursor, exposing theadjunct precursor to light energy, applying a hardener to the adjunctprecursor, waiting a selected time duration after deposition, etc.

In one embodiment, the adjunct precursor 15500 can be a biologicallycompatible heterogeneous mixture including one or more solid componentsand one or more solvents. The solvent(s) can evaporate over time due tobody heat from the tissue 15502 and/or externally supplied heat, formingthe solid adjunct from the remaining solid components.

In an alternative embodiment, the adjunct precursor 15500 can be abiologically compatible chemical composition that solidifies (e.g.,cures or hardens) after exposure to one or more of light energy (e.g.,ultraviolet light), heat, or one or more co-reactants (e.g., catalysts,hardeners, etc.). Solidification of the chemical composition can takethe form of cross-linking between components of the chemical compositionor components of the chemical composition and co-reactants. Embodimentsof the adjunct precursor 15500 that are configured to solidify afterexposure to one or more co-reactants can receive the co-reactants in avariety of ways. In one aspect, the co-reactant can be mixed with theadjunct precursor 15500 at a selected time prior to deposition upon thetissue 15502 (e.g., immediately prior to deposition). In another aspect,the co-reactant can be applied to the adjunct precursor 15500 afterdeposition (e.g., by a dropper or sprayer). In a further aspect, theco-reactant can be transferred from the surface of an object to theadjunct precursor 15500 by contact. For example, as shown in FIG. 5C, amesh 15510 including the co-reactant can be applied to the depositedadjunct precursor 15500 prior to solidification (e.g., over the adjunctprecursor 15500 and/or embedded within the deposited adjunct precursor15500). The co-reactant can be positioned on the surface of the mesh15510 or contained within the mesh 15510 and released upon contact withthe adjunct precursor 15500. Alternatively or additionally, at least aportion of the mesh 15510 can be formed from the co-reactant. In furtherembodiments, the co-reactant can be provided in any combination of theabove. Beneficially, use of the mesh 15510 can provide furtherreinforcement to the solid precursor.

Following solidification of the adjunct precursor 15500 to form thesolid adjunct 15512, one or more staples 15514 can be delivered throughthe solid adjunct 15512 and into the tissue 15502. As illustrated inFIGS. 128D-128E, the end effector 30 of the stapler 10 can grasp thetissue 15502 at the location of the solid adjunct 15512 using the jaws32, 34 and the firing system can be actuated to eject one or morestaples 15514 into the clamped tissue 15502. As discussed above, theknife blade 36 (see FIG. 3) or other cutting element can be associatedwith the firing system to cut the tissue 15502 during the staplingprocedure, after tissue fixation has started.

FIGS. 129A-129B illustrate placement of another embodiment of an adjunct15600 upon a surface of a tissue 15602 by an adjunct delivery device15604. The adjunct delivery device 15604 can generally be configured andused similarly to the stapler 10 for grasping the tissue 15602, exceptthat the staple cartridge and firing system are omitted. As an example,the adjunct delivery device 15604 can include an elongate shaft 15606having a non-stapling end effector 15610 at a distal end 15606 d withopposed first and second jaws 15612, 15614 configured to grasp thetissue 15602 therebetween. The adjunct delivery device 15604 can furtherinclude a handle assembly (not shown) connected to a proximal end of theshaft 15606 and configured to manipulate and operate the non-staplingend effector 15610 similar to the handle assembly 12.

The non-stapling end effector 15610 can be configured to secure theadjunct 15600 thereon for placement of the adjunct 15600 at a treatmentsite of the tissue 15602 and to release the adjunct 15600 when thetissue 15602 is engaged by the non-stapling end effector 15610. Asillustrated in FIGS. 129A-129B, the first and second jaws 15612, 15614can include approximately flat tissue contacting surfaces 15616, 15620with a plurality of sockets 15622, 15624. The sockets 15622, 15624 areconfigured to receive corresponding barbed pins 15626, 15630. When theadjunct 15600 is positioned on the tissue contacting surfaces 15616,15620, the barbed pins 15626, 15630 extend through the adjunct 15600,securing the adjunct 15600 thereto by frictional engagement. After theadjunct 15600 is positioned adjacent to the tissue 15602, the jaws15612, 15614 can be compressed to engage the tissue 15602. Thecompressive force exerted by the jaws 15612, 15614 can drive a portionof the barbed pins 15626, 15630 into the tissue 15602. Thus, when thejaws 15612, 15614 are retracted from the tissue 15602, the barbed pins15626, 15630 are retained in the tissue and the frictional engagementthe barbed pins 15626, 15630 and the adjunct 15600 retains the adjunct15600 in position on the tissue 15602 prior to stapling.

As shown, the adjunct 15600 can be formed from a single piece ofmaterial that includes a hinge 15632. This hinged configuration canallow a first adjunct portion 15600 a on one side of the hinge 15632 tobe retained on the first jaw 15612 by the barbed pins 15626 and a secondadjunct portion 15600 b on the other side of the hinge 15632 to beretained on the second jaw 15614 by the barbed pins 15630. Beneficially,because the first and second adjunct portions 15600 a, 15600 b areconnected by the hinge 15632, the first and second adjunct portions15600 a, 15600 b remain aligned when positioned on opposing sides of thetissue 15602. The adjunct 15600 and the barbed pins 15626 can be formedfrom bioabsorbable materials, as discussed above, so that they areabsorbed by the body during healing.

Optionally, the first and second adjunct portions 15600 a, 15600 b caninclude a plurality of holes 15634 for receiving corresponding barbedpins 15626, 15630. The holes 15634 can possess a diameter smaller than adiameter the barbed pins 15626, 15630 to facilitate frictionalengagement of the adjunct 15600 with the barbed pins 15626, 15630.Alternatively, the holes 15634 can be omitted and the barbed pins 15626,15630 can puncture the adjunct 15600 for frictional engagement whenpositioned on the jaws 15612, 15614.

Following placement of the adjunct 15600 upon the tissue 15602 by theadjunct delivery device 15604, one or more staples 15636 can bedelivered through the adjunct 15600 and into the tissue 15602. Asillustrated in FIGS. 130A-130B, the end effector 30 of the stapler 10can grasp the tissue 15602 at the location of the adjunct 15600 usingthe jaws 32, 34 and the firing system can be actuated to eject one ormore staples 15636 into the clamped tissue 15602. As discussed above,the knife blade 36 (see FIG. 3) or other cutting element can beassociated with the firing system to cut the tissue 15602 during thestapling procedure, after tissue fixation has started.

A person skilled in the art will appreciate that, while FIGS. 129A-130Billustrate the adjunct 15600 as a generally planar structure includingthe hinge 15632, the adjunct 15600 can adopt any desired shape. In oneexample (not shown), the hinge 15632 can be omitted and adjunct can beformed from two separate pieces that are secured to respective jaws15612, 15614.

In another example, FIGS. 131A-131C illustrate a flanged adjunct 15800configured to be positioned on a tissue 15802 by the adjunct deliverydevice 15604. The flanged adjunct 15800 includes flanges 15804 alonglateral edges that, when mounted on the adjunct delivery device 15604,extend towards respective jaws 15612, 15614 upon which the flangedadjunct 15800 is mounted. When positioned on the tissue 15802, theflanges 15804 can be dimensioned to facilitate alignment of a stapler 10with the flanged adjunct 15800 for delivery of one or more staples 15806through the flanged adjunct 15800 and tissue 15802. Optionally, theflanged adjunct 15800 can be formed from a single, continuous piece witha hinge (not shown), as discussed above, to maintain alignment betweenrespective portions of the flanged adjunct 15800. In either instance,the flanged adjunct 15800 can be delivered to tissue, and subsequentlythe flanges 15804 can guide the jaws 15612, 15614 into alignment withthe flanged adjunct 15800 for staple delivery.

Another embodiment of an adjunct system 15900 configured for use withthe stapler 10 is illustrated in FIGS. 132A-132B. The adjunct system15900 includes an adjunct 15902 and a sheet of material 15904, differentfrom the adjunct 15902. The adjunct 15902 can be configured to beattached to the first jaw 32 including the staple cartridge 40containing a plurality of staples and the sheet of material 15904 can beconfigured to be attached to the second jaw 34. In certain embodiments,the adjunct 15902 is only attached to the first jaw 32 and not thesecond jaw 34. The first and second jaws 32, 34 can include one or moreattachment mechanisms for securing the adjunct 15902 and the sheet ofmaterial 15904 thereto. Examples of attachment mechanisms can include,but not limited to, adhesives, protrusions, etc. The strength with whichthe attachment mechanism secures the adjunct 15902 and sheet of material15904 to respective jaws 32, 34 can be sufficient to retain adjunct15902 and sheet of material 15904 thereon during placement of theadjunct system 15900 on a tissue 15906 and to release the adjunct 15902and the sheet of material 15904 when staples are deployed through theadjunct 15902. As an example, when the end effector 30 fires a pluralityof staples 15910 through the adjunct 15902, the sheet of material 15904,and the tissue 15906, the staples 15910 can secure the adjunct 15902 tothe tissue 15906 with sufficient force to retain the adjunct 15902 onthe tissue 15906 when the end effector 30 is retracted from the tissue15906 (FIG. 132B).

Terminology

It will be appreciated that the terms “proximal” and “distal” are usedherein with reference to a user, such as a clinician, gripping a handleof an instrument. Other spatial terms such as “front” and “back”similarly correspond respectively to distal and proximal. It will befurther appreciated that for convenience and clarity, spatial terms suchas “vertical” and “horizontal” are used herein with respect to thedrawings. However, surgical instruments are used in many orientationsand positions, and these spatial terms are not intended to be limitingand absolute.

A person skilled in the art will appreciate that the present inventionhas application in conventional minimally-invasive and open surgicalinstrumentation as well application in robotic-assisted surgery. In someembodiments, the devices and methods described herein are provided foropen surgical procedures, and in other embodiments, the devices andmethods are provided for laparoscopic, endoscopic, and other minimallyinvasive surgical procedures. The devices may be fired directly by ahuman user or remotely under the direct control of a robot or similarmanipulation tool. However, a person skilled in the art will appreciatethat the various methods and devices disclosed herein can be used innumerous surgical procedures and applications. Those skilled in the artwill further appreciate that the various instruments disclosed hereincan be inserted into a body in any way, such as through a naturalorifice, through an incision or puncture hole formed in tissue, orthrough an access device, such as a trocar cannula. For example, theworking portions or end effector portions of the instruments can beinserted directly into a patient's body or can be inserted through anaccess device that has a working channel through which the end effectorand elongated shaft of a surgical instrument can be advanced.

Furthermore, the devices disclosed herein can be designed to be disposedof after a single use, or they can be designed to be used multipletimes. In either case, however, the device can be reconditioned forreuse after at least one use. Reconditioning can include any combinationof the steps of disassembly of the device, followed by cleaning orreplacement of particular pieces and subsequent reassembly. Inparticular, the device can be disassembled, and any number of theparticular pieces or parts of the device can be selectively replaced orremoved in any combination. Upon cleaning and/or replacement ofparticular parts, the device can be reassembled for subsequent useeither at a reconditioning facility, or by a surgical team immediatelyprior to a surgical procedure. Those skilled in the art will appreciatethat reconditioning of a device can utilize a variety of techniques fordisassembly, cleaning/replacement, and reassembly. Use of suchtechniques, and the resulting reconditioned device, are all within thescope of the present application.

One skilled in the art will appreciate further features and advantagesof the invention based on the above-described embodiments. Accordingly,the invention is not to be limited by what has been particularly shownand described, except as indicated by the appended claims. Allpublications and references cited herein are expressly incorporatedherein by reference in their entirety.

What is claimed:
 1. A method for stapling tissue, comprising:positioning an adjunct on one of first and second jaws of an endeffector of a surgical stapler, the adjunct having an adhesive thereonthat maintains the adjunct on the jaw; and positioning tissue betweenthe first and second jaws, and actuating the surgical stapler to causethe first and second jaws to move from an open position to a closedposition in which the tissue is engaged therebetween; wherein a firstattachment mechanism on the adjunct prevents stretching of at least aportion of the adjunct.
 2. The method of claim [0007], wherein the firstattachment mechanism comprises at least one post formed on one of theadjunct and the jaw, and at least one bore formed on the other one ofthe adjunct and the jaw for receiving the post.
 3. The method of claim[0007], wherein a second attachment mechanism on the adjunct preventssliding of the adjunct relative to the jaw having the adjunct disposedthereon.
 4. The method of claim [0008], wherein the second attachmentmechanism on the adjunct prevents lateral sliding of the adjunctrelative to a longitudinal axis of the jaw.
 5. The method of claim[0008], wherein the second attachment mechanism on the adjunct preventslongitudinal sliding of the adjunct relative to a longitudinal axis ofthe jaw.
 6. The method of claim [0007], wherein a second attachmentmechanism on the adjunct prevents curling of a distal-most end of theadjunct when the tissue is positioned between the first and second jaws.7. A method for stapling tissue, comprising: positioning an adjunct onat least one jaw of first and second jaws of an end effector of asurgical stapler, the adjunct being maintained on the at least one jawin a first state in which the adjunct is at least partially stretchedover the at least one jaw; and positioning tissue between the first andsecond jaws, and actuating the surgical stapler to cause the first andsecond jaws to move from an open position to a closed position in whichthe tissue is engaged therebetween; wherein the actuation of thesurgical stapler causes the adjunct to transition from the first stateto a second state such that the adjunct in the second state at leastpartially separates from the at least one jaw.
 8. The method of claim 7,wherein the actuation of the surgical stapler comprises causing acutting element of the surgical stapler to move to thereby cut throughat least a portion of the adjunct to cause the adjunct to transitionfrom the first state to the second state.
 9. The method of claim 8,wherein the cutting element cuts through at least a portion of theattachment feature as the cutting element moves.
 10. The method of claim7, wherein the actuation of the surgical stapler comprises causingstaples to be deployed to thereby penetrate through at least a portionof the adjunct to cause the adjunct to transition from the first stateto the second state.